Pancuronium
Mechanism :
Pancuronium is a nondepolarizing neuromuscular blocking agent. It acts by competing for cholinergic receptors at the motor end-plate. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine and edrophonium.
Indication :
- Neuromuscular blockade
- Ventilation
Contraindications :
Contraindicated in patients known to have hypersensitivity to pancuronium bromide. Use with caution in severe renal impairment as duration of action is prolonged. Since pancuronium causes relaxation of the respiratory muscles, respiration must be assisted in all patients.
Dosing :
Neonates: IV loading 0.02 mg/kg followed by maintenance IV 0.05-0.1 mg/kg/dose every 30 mins to 4 hours, as and when needed.
1 month-18 years: 0.04-0.1 mg/kg IV initially followed by 0.015-0.01 mg/kg every half to one hour, OR continuous IV: 0.1 mg/kg/hr.
Adverse Effect :
Tachycardia, hypertension, excessive salivation, transient rashes, wheezing, histamine release.
Interaction :
Aminoglycosides, Metronidazole, Polymyxins, Suxamethonium, Nifedipine, Verapamil, Propranolol, Procainamide, Quinidine, Lithium and Parenteral Magnesium, High Doses of Thiopental, Ketamine, Fentanyl, Beta-Blockers and Diuretics: Enhanced effect.
Corticosteroids, Phenytoin and Carbamazepine: Decreased effect.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Initial dose: 25–50 micrograms/kg Incremental dose: 5–10 micrograms/ kg |
| <10 | Initial dose: 10–25 micrograms/kg Incremental dose: 2.5–5 micrograms/kg |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HD | Unknown dialysability. Dose as in GFR<10 mL/min |
| HDF/High flux | Unknown dialysability. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Elimination half-life is doubled, plasma clearance is doubled, recovery time is prolonged, volume of distribution is increased (50%) and results in a slower onset, higher total dosage, and prolongation of neuromuscular blockade. Patients with liver disease may develop slow resistance to non-depolarizing muscle relaxant. Large doses may be required and problems may arise in antagonism.