Pancuronium

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What is Pancuronium

Pancuronium is a parenteral, long-acting, nondepolarizing, neuromuscular blocking agent indicated as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Pancuronium is approximately one-third less potent than vecuronium, with a longer duration of action at initially equipotent doses.

Pancuronium has little effect on histamine release at usual doses and is not likely to cause clinically significant bronchospasm compared to agents with histamine-releasing properties such as atracurium and succinylcholine; however, pancuronium may cause significant tachycardia and hypertension due to vagolytic properties.

Indications

  1. endotracheal intubation
  2. neuromuscular blockade during mechanical ventilation
  3. neuromuscular blockade during surgery
  4. rapid-sequence intubation
  5. shaking chills

Side Effects

  1. acute quadriplegic myopathy syndrome
  2. anaphylactoid reactions
  3. angioedema
  4. anxiety
  5. apnea
  6. bronchospasm
  7. conjunctivitis
  8. dyspnea
  9. erythema
  10. flushing
  11. hypersalivation
  12. hypertension
  13. hypotension
  14. hypoxia
  15. keratitis
  16. malignant hyperthermia
  17. muscle paralysis
  18. myopathy
  19. pruritus
  20. rash
  21. respiratory depression
  22. sinus tachycardia
  23. skin erosion
  24. skin ulcer
  25. thrombosis
  26. tolerance
  27. urticaria
  28. weakness
  29. wheezing
  30. xerophthalmia

Monitoring Parameters

  • peripheral nerve stimulation

Contraindications

  • accidental exposure
  • acid/base imbalance
  • adrenal insufficiency
  • asthma
  • biliary obstruction
  • breast-feeding
  • bromide hypersensitivity
  • burns
  • cardiac disease
  • chronic lung disease (CLD)
  • chronic obstructive pulmonary disease (COPD)
  • dehydration
  • edema
  • electrolyte imbalance
  • geriatric
  • hepatic disease
  • hypercalcemia
  • hypermagnesemia
  • hypocalcemia
  • hypokalemia
  • hypothermia
  • labor
  • malignant hyperthermia
  • metabolic acidosis
  • metabolic alkalosis
  • myasthenia gravis
  • neonates
  • neuromuscular blocking agent hypersensitivity
  • neuromuscular disease
  • obesity
  • obstetric delivery
  • pregnancy
  • premature neonates
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • requires a specialized care setting
  • requires an experienced clinician
  • respiratory acidosis
  • respiratory alkalosis
  • tachycardia

Interactions

  • Acebutolol
  • Acetazolamide
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Amide local anesthetics
  • Aminoglycosides
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Atenolol
  • Atenolol; Chlorthalidone
  • Bacitracin
  • Bendroflumethiazide; Nadolol
  • Beta-blockers
  • Betaxolol
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Botulinum Toxins
  • Brimonidine; Timolol
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium-channel blockers
  • Calcium; Vitamin D
  • Capreomycin
  • Carbonic anhydrase inhibitors
  • Carteolol
  • Carvedilol
  • Chromium
  • Clevidipine
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Cyclophosphamide
  • Cyclosporine
  • Demeclocycline
  • Desflurane
  • Dextromethorphan; Quinidine
  • Digoxin
  • Diltiazem
  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxycycline
  • Enalapril; Felodipine
  • Enflurane
  • Entecavir
  • Esmolol
  • Ester local anesthetics
  • Felodipine
  • Fosphenytoin
  • Galantamine
  • Hetastarch; Dextrose; Electrolytes
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Indapamide
  • Irinotecan
  • Irinotecan Liposomal
  • Isoflurane
  • Isradipine
  • Ketorolac
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Lincosamides
  • Lithium
  • Loop diuretics
  • Magnesium
  • Methazolamide
  • Metoprolol
  • Minocycline
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Neostigmine
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Omadacycline
  • Penbutolol
  • Perindopril; Amlodipine
  • Phenytoin
  • Physostigmine
  • Pindolol
  • Piperacillin
  • Piperacillin; Tazobactam
  • Polymyxin B
  • Polymyxins
  • Procainamide
  • Propranolol
  • Pyridostigmine
  • Quinidine
  • Quinine
  • Ranitidine
  • Rivastigmine
  • Sarecycline
  • Sevoflurane
  • Sotalol
  • Succinylcholine
  • Tetracycline
  • Tetracyclines
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Timolol
  • Trandolapril; Verapamil
  • Trospium
  • Vancomycin
  • Verapamil

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