What is Vecuronium (a non-depolarizing neuromuscular blocking agent)?

From the Guidelines

Vecuronium is an intermediate-acting non-depolarizing neuromuscular blocking agent (NMBA) that is a structural analogue of pancuronium and is not vagolytic, with a typical adult dose of 0.08-0.1 mg/kg IV initially, followed by maintenance doses of 0.01-0.015 mg/kg as needed, and a continuous infusion rate of 0.8-1.2 mcg/kg/min for prolonged procedures.

Key Characteristics of Vecuronium

• It produces blockade within 60–90 seconds and typically lasts 25–30 minutes after an initial IV bolus dose 1.
• The drug is metabolized primarily by the liver with some renal elimination, and its duration of action may be prolonged in patients with hepatic or renal impairment 1.
• Vecuronium offers hemodynamic stability, making it suitable for patients with cardiovascular disease.
• When administering vecuronium, proper monitoring with a peripheral nerve stimulator is essential to assess the degree of neuromuscular blockade.
• At the end of the procedure, neuromuscular blockade can be reversed with neostigmine (0.04-0.07 mg/kg) combined with an anticholinergic like glycopyrrolate (0.01 mg/kg).

Important Considerations

• Patients receiving NMBAs, including vecuronium, should be assessed both clinically and by TOF monitoring, with a goal of adjusting the degree of neuromuscular blockade to achieve one or two twitches 1.
• Before initiating neuromuscular blockade, patients should be medicated with sedative and analgesic drugs to provide adequate sedation and analgesia in accordance with the physician’s clinical judgment to optimize therapy 1.
• Prolonged use of vecuronium, like other NMBAs, may be associated with skeletal muscle weakness, myopathy, and other complications, particularly in critically ill patients 1.

From the FDA Drug Label

Vecuronium bromide for injection is a nondepolarizing neuromuscular blocking agent of intermediate duration Vecuronium for injection is a nondepolarizing neuromuscular blocking agent possessing all of the characteristic pharmacological actions of this class of drugs (curariform)

Vecuronium is a non-depolarizing neuromuscular blocking agent used to produce muscle relaxation. It acts by competing for cholinergic receptors at the motor end-plate, inhibiting the antagonism to acetylcholine and reversing neuromuscular block with acetylcholinesterase inhibitors such as neostigmine, edrophonium, and pyridostigmine 2.

From the Research

Definition and Classification of Vecuronium

• Vecuronium is a non-depolarizing neuromuscular blocking agent 3
• It is classified as an intermediate-acting agent 4, 3

Onset and Duration of Action

• The onset time of vecuronium decreases with increasing doses, ranging from 208 +/- 41 seconds at 100 micrograms/kg to 106 +/- 35 seconds at 400 micrograms/kg 5
• The duration of action of vecuronium increases with increasing doses, ranging from 37 +/- 13 minutes at 100 micrograms/kg to 138 +/- 24 minutes at 400 micrograms/kg 5
• The clinical duration of vecuronium is approximately 42.5 +/- 9.1 minutes at a dose of 0.1 mg/kg 4

Comparison with Other Agents

• Vecuronium has a slower onset time compared to rocuronium, with an onset time of 102.8 +/- 26.9 seconds versus 54.9 +/- 10.9 seconds 4
• Vecuronium has a faster onset time compared to pancuronium, with an onset time of 4 minutes versus 6 minutes at a dose of 0.1 mg/kg 6
• Vecuronium has a slower onset time compared to suxamethonium, with an onset time of 4 minutes versus 2 minutes at a dose of 1.0 mg/kg 6

Intubation Conditions

• Vecuronium provides good to excellent intubation conditions, with atraumatic intubation possible within 2 minutes at a dose of 0.1 mg/kg 6
• The intubation conditions with vecuronium are similar to those with rocuronium 4