From the Guidelines
The most common side effect of pancuronium is tachycardia (option a). Pancuronium bromide is a non-depolarizing neuromuscular blocking agent that works by competitively blocking acetylcholine receptors at the neuromuscular junction. While it effectively produces muscle relaxation for surgical procedures and mechanical ventilation, pancuronium has vagolytic properties that block parasympathetic activity. This vagolytic effect leads to an increase in heart rate (tachycardia) by reducing parasympathetic tone on the heart, as noted in a study published in 2016 1. The tachycardia is typically dose-dependent and can be clinically significant, especially in patients with cardiovascular disease or those who cannot tolerate increases in heart rate.
According to the study published in 2002 1, more than 90% of ICU patients will have an increase in heart rate of 10 beats/min, which limits its use in patients who cannot tolerate an increase in heart rate. This side effect distinguishes pancuronium from some other neuromuscular blockers like cisatracurium or vecuronium, which have minimal cardiovascular effects, as mentioned in the 2016 study 1. Clinicians should monitor heart rate closely when administering pancuronium, particularly in patients with coronary artery disease, hypertension, or other conditions where tachycardia could be detrimental. Key points to consider when using pancuronium include:
- Vagolytic properties leading to tachycardia
- Dose-dependent increase in heart rate
- Potential for clinically significant tachycardia in patients with cardiovascular disease
- Need for close monitoring of heart rate in susceptible patients.
From the Research
Common Side Effects of Pancuronium
The most common side effect of pancuronium is related to its impact on the cardiovascular system. Based on the available evidence, the following points can be noted:
- Tachycardia is a significant side effect associated with pancuronium, as observed in several studies 2, 3, 4.
- The use of pancuronium can lead to increased heart rate in a dose-dependent manner 3.
- Beta-blocker therapy can attenuate the tachycardic effect of pancuronium 2, 3.
- Pancuronium may also cause hypertension, although this is not as consistently reported as tachycardia 5.
- Other side effects, such as hypotension, hyperkalemia, hyperthermia, and renal insufficiency, are not as commonly associated with pancuronium based on the provided evidence.
Comparison with Other Options
In comparison to other options:
- Vecuronium is often associated with a decrease in heart rate or no significant change 6, 4.
- Rocuronium and mivacurium may also increase heart rate, but the changes are not always statistically significant 3.
- Atracurium can cause hypotension in some cases 4.
- Pipecuronium has a similar neuromuscular-blocking effect to pancuronium but lacks significant cardiovascular effects 4.
Conclusion Not Provided
As per the instructions, no conclusion will be drawn from the evidence presented. The information provided is based on the studies cited 2, 3, 6, 5, 4.