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Vecuronium

  • 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 

Disclaimer:  This Drug information was designed for use by PIPER Neonatal. Whilst great care has been taken to check the information is accurate, it is possible that errors may have been missed. Furthermore, dosage schedules are continually being revised and new side effects recognised. For these reasons, the reader is strongly advised to consult the drug companies' printed information before administering any of the drugs recommended in this book.
Most drugs in this document are appropriate only for specialist use in hospitals.  A number of drugs should only be used in consultation with the appropriate Paediatric subspecialist. 

Note: The electronic version of this guideline is the version currently in use.  Any printed version cannot be assumed to be current. Printed copies of this document are valid for