OB-GYN 101
Pharmacy

Category:

• Muscle relaxant

Description:

• Nondepolarizing skeletal muscle relaxant

Indications:

• Adjunct to general anesthesia to facilitate intubation and skeletal muscle relaxation

• Maintenance of muscle relaxation in patients undergoing mechanical ventilation

Contraindications:

Precautions:

• Pregnancy category C

• Only used by skilled personnel in airway management and respiratory support.

• Use with caution in patients with myasthenia gravis due to profound effects to small doses.

• Must have anticholinesterase reversal agents immediately available during use.

• Use with caution in patients with hepatic or biliary tract disease due to decreased medication clearance.

• Contains benzyl alcohol that may cause “gasping syndrome” in premature infants.

• Use with caution is severely obese patients or neuromuscular disease.

• The intensity and duration of pancuronium activity is enhanced by potent inhalation agents and succinylcholine.

  Adverse Reactions (Side Effects):

• Neuromuscular: extension of action beyond completion of surgery

• Cardiovascular: tachycardia, increased arterial pressure, increased cardiac output

• Dermatologic: transient rash

• Increased salivation during anesthesia

• Administered via IV injection

• Bolus:

  • Initial adult dose: 0.04-0.1mg/kg IV bolus

  • Maintenance doses start at 0.01mg/kg

  • Endotracheal intubation: 0.06-0.1mg/kg bolus dose, intubation usually in 2-3 minutes

• Pediatric dose:

  • Children: no adjustments needed

  • Neonates: give test dose of 0.02mg/kg to check responsiveness

  • Children 1 month – 2 years old: 0.3-0.4mg/kg