Category:

• Muscle relaxant

Description:

• Nondepolarizing skeletal muscle relaxant

Indications:

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

Contraindications:

Precautions:

• Pregnancy category C

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

• Must have anticholinesterase reversal agents immediately available during use.

• Will cause histamine release.  Use with caution in patients susceptible to histamine, such as cardiovascular disease and asthma.

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

• May cause bradycardia during anesthesia.

• Use with caution in patients with neuromuscular disease.

• May cause malignant hyperthermia in susceptible patients.

• Use a peripheral nerve stimulator to monitor twitch suppression and recovery.

• IM injection may cause tissue irritation.

Adverse Reactions (Side Effects):

• Cardiovascular: hypotension (up to 14%), vasodilation (up to 9%), tachycardia (up to 5%), bradycardia

• Dermatologic: rash, urticaria, injection-site reactions

• Respiratory: dyspnea, broncho- and laryngospasm

Dosage:

• Administered via IV injection (IM may cause tissue irritation)

• Bolus:

  • Initial adult dose: 0.4-0.5mg/kg IV bolus

  • Maintenance adult dose: 0.08-0.1mg/kg every 15-25 minutes to maintain blockade

• Pediatric dose:

  • Children > 2 years old: no adjustments needed

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