Description and indication for use
Vecuronium
is a non-depolarising muscle relaxant (shorter-acting than Pancuronium). It
blocks transmission of motor nerve impulses to the striated muscle receptors
causing muscle relaxation and paralysis.
The
onset of action for Vecuronium is 2 – 5 minutes. The duration of action varies
with dose and age but is approximately 60 minutes in infants.
Vecuronium
is less likely to cause cardiovascular effects and does not release clinically
significant amounts of histamine so may be preferable to Pancuronium. It is
used for unstable babies in whom it is desirable that they are not breathing
against the ventilator. The desirable effects of Vecuronium are improvement of
ventilation and oxygenation and minimisation of fluctuations in cerebral blood
flow.
Dose
IV Bolus:
100
micrograms/kg/dose over 30 seconds. Repeat 1 – 2 hourly or when necessary.
IV Infusion:
Commence
at 1 – 2 micrograms/kg/minute.
Antidote: Neostigmine 50 micrograms/kg with
Atropine 20 microgram/kg.
Note: Dosage may need reduction if used with other anaesthetic or
neuromuscular blocking drugs.
Onset usually occurs in 2 – 3
mins and lasts 20
– 40 mins.
Duration may be prolonged in infants and
neonates.
Reconstitution/Dilution
Ampoule
= 4 mg (powder for reconstitution).
Reconstitute
with 4 mL water for injection = 1 mg/mL.
IV Infusion:
After
reconstitution add 6 mg/kg to infusion solution (Glucose 5% or Sodium Chloride
0.9%) to a total volume of 50 mL (as shown in table below).
Excess solution must be discarded.
Drug
How to Make Up
|
DRUG
|
HOW TO MAKE UP
|
DOSE EQUIVALENT
|
DOSE RANGE
|
|
Vecuronium
|
6 mg/kg
in 50 mL in Glucose 5% or Sodium Chloride 0.9%
|
1 mL/hr
= 2 micrograms/kg/min
|
1
to 10 micrograms/kg/min
|
|
12 mg/kg
in 50 mL in Glucose 5% or Sodium Chloride 0.9%
|
1 mL/hr
= 4 micrograms/kg/min
|
Route and method
of administration
IV:
Give
as a push over 30 seconds. Flush line with Sodium Chloride 0.9%.
IV Infusion:
Give
as a continuous infusion at the prescribed rate via syringe pump.
Side effects
Fluid retention due to immobility.
Dry eyes.
Contraindications
Non-ventilated patients.
Ventilated babies with no analgesia and/or
sedation.
CAUTION in patients with encephalopathy – muscle relaxation may make
neurological assessment difficult and mask seizures.
CAUTION in patients with anuria and/or worsening fluid retention.
Drug interactions
|
Aminoglycosides (Gentamicin,
Amikacin, Tobramycin) and Vancomycin
|
May enhance the
action of Vecuronium.
|
|
Corticosteroids (Dexamethasone, Hydrocortisone)
|
May reduce
effectiveness of Vecuronium.
|
|
Frusemide
|
May alter
effectiveness of Vecuronium.
|
|
Magnesium Sulphate
|
May potentiate
the action of Vecuronium.
|
|
Phenytoin
|
May reduce
effectiveness of Vecuronium.
|
Nursing responsibilities
Monitor hourly heart rate, blood pressure
and oxygenation saturation during muscle relaxation.
Ensure adequate analgesia and/or sedation.
Remain by the bedside until effects of IV
bolus Vecuronium are complete or the IV infusion has been running for at least
30 minutes.
Monitor for renal or hepatic impairment – dosage
reduction may be necessary.
Consider need for bladder catheterization
if urine output decreases.
Ensure use of eye lubricating drops to
avoid side effects of muscle relaxation.
Monitor for movement.
Protect vecuronium syringe from light.
Cover syringe with foil.
Compatibility
Information
IMPORTANT: Contact Pharmacy for drugs not appearing in the table below.
Uncommon drugs have simply been omitted and may be incompatible.
Incompatible
Fluids
Glucose 10%*
Alkaline Solutions*, TPN**
Drugs
Do
not mix with other drugs.
Amphotericin
B, Diazepam, Frusemide, Phenytoin, Sodium Bicarbonate.
Y-Site
Adrenaline,
Dobutamine, Dopamine, Fluconazole, Gentamicin, Glyceryl Trinitrate, Heparin, Hydrocortisone
Sodium Succinate, Midazolam, Morphine Sulphate, Noradrenaline, Ranitidine, Vancomycin.
#NOTE: There is no compatibility information available
with glucose 10%.
*NOTE: Vecuronium is unstable in alkaline solutions
and should not be combined with alkaline drugs or administered through a line
with an alkaline solution.
**NOTE: There is limited
information on the compatibility of Vecuronium with parenteral nutrition (PG1,
PG2 and intralipid solutions). For this reason please avoid mixing the two
together or administering via Y-site