Pancuronium

Aka: Pancuronium, Pavulon

1. See Also
   1. Paralytic Agent
2. Precautions
   1. Used only in anesthesia, emergency and intensive care
   2. Airway and respiratory control is critical after use
   3. Paralytic Agents do not alter Level of Consciousness
      1. Must be used with sedation and analgesia
3. Indication
   1. Paralysis in Rapid Sequence Intubation
   2. Maintenance of paralysis
   3. Neuromuscular Blockade drug of choice
      1. Except when contraindicated (see below)
4. Contraindications
   1. Renal Failure (Creatinine Clearance <10 ml/min)
   2. Hepatic failure (due to up to 45% hepatic metabolism)
   3. Unstable cardiovascular status
   4. Shorter duration of action needed
5. Mechanism
   1. Non-depolarizing Neuromuscular Blocking Agent
   2. Structurally similar to Vecuronium
      1. Same steroid nucleus
      2. Quaternary Nitrogen at position 2 is only difference
   3. Significantly different effects than Vecuronium
      1. Primarily renal excretion (up to 70%)
      2. Tachycardia due to vagolytic and Sympathomimetic
      3. Significantly longer duration of action
6. Dose
   1. Initial Dose
      1. Pancuronium alone: 0.06 to 0.1 mg/kg IV
      2. Pancuronium after Succinylcholine: 0.05 mg/kg IV
   2. Maintenance dosing (if needed)
      1. Starts 25-60 minutes after initial dose
      2. Please see other references for maintenance dosing
   3. Renal Impairment
      1. Cut dose by 50% if CrCl 10-50 ml/min
      2. Do not use Pancuronium if CrCl <10 ml/min
   4. Do not use by intramuscular dosing
7. Pharmacokinetics
   1. Onset: 2-3 minutes
   2. Duration: 40-60 minutes
8. References
   1. Miller in Katzung (1989) Pharmacology, p. 323-33
   2. Savarese in Miller (2000) Anesthesia, p. 412-90
   3. (2003) Lexicomp Drug database for Pocket PC