Understanding Anesthesiology - The Global Regional Anesthesia ...

PANCURONIUM BROMIDE
Class
Nondepolarizing skeletal muscle relaxant (NDMR);
long-acting
Mechanism of Action
Competitive inhibitor at the acetylcholine receptors of
the post-synaptic cleft of the neuromuscular junction.
Dose
Intubation: 0.1 mg/kg IV
Maintenance bolus: 0.01-0.03 mg/kg
Onset
4-5 minutes
Duration
45-65 minutes
MSK
The neuromuscular blockade effects of non-depolarizing
muscle relaxants are potentiated by succinylcholine,
volatile anesthetics, aminoglycosides, lithium, loop diuretics,
lidocaine, magnesium, lithium, ganglionic blockers,
hypothermia, hypokalemia and respiratory acidosis.
Enhanced neuromuscular blockade is seen in patients
with myasthenia gravis or myopathies.
The effects of NDMR are antagonized by cholinesterase
inhibitors. Increased resistance to NDMR is seen in patients
on theophylline, burn patients and those with paresis
or paralysis.
Misc.
Muscle relaxants are the most common cause of anaphylactoid
reactions under general anesthesia.
Elimination
Renal (80%), hepatic (minor)
Effects
CVS
Pancuronium has a vagolytic effect and therefore
causes tachycardia and hypertension. Increased risk of
arrhythmias in patients receiving tricyclic antidepressants
and volatile anesthetics.
Respiratory
May promote bronchospasm, salivation.
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