Does Vecuronium Reduce Blood Pressure?
No, vecuronium does not reduce blood pressure and is hemodynamically neutral at standard clinical doses. This makes it particularly advantageous compared to other neuromuscular blocking agents that can cause significant cardiovascular changes.
Hemodynamic Profile of Vecuronium
Vecuronium has minimal to no effect on blood pressure, heart rate, or other cardiovascular parameters at clinically relevant doses. 1, 2
Evidence from Clinical Studies
In healthy surgical patients receiving vecuronium 0.1 mg/kg (standard dose) or 0.3 mg/kg (3× standard dose), no significant changes in heart rate, arterial blood pressure, or cardiac index were observed 2
Studies in patients undergoing coronary artery bypass grafting demonstrated that vecuronium 0.28 mg/kg (12× the ED90 dose) produced no significant changes in heart rate or mean arterial pressure, while cardiac output increased only 9% and systemic vascular resistance decreased only 12% 3
In ICU patients, vecuronium 0.1 mg/kg and 0.3 mg/kg caused no hemodynamic changes, with only minimal effects at the higher dose: a slight 5% decrease in arterial pressure and a transient 3% increase in heart rate lasting only 3 minutes 2
In geriatric patients (mean age 83 years) with circulatory deficiency, vecuronium produced no hemodynamic side effects 2
Comparison to Other Neuromuscular Blocking Agents
Vecuronium's hemodynamic stability contrasts sharply with other agents:
Pancuronium causes significant increases in heart rate (+12-22%), blood pressure (+8-24%), and cardiac index (+8-17%) due to vagolytic effects 2, 3
d-Tubocurarine causes significant decreases in arterial pressure (-24%) and cardiac index (-17%) due to histamine release 2
Meperidine (when used for shivering control) significantly lowers systolic blood pressure, whereas vecuronium eliminates shivering without lowering blood pressure 4
Clinical Implications
Advantages in Specific Populations
Cardiac patients: Vecuronium 0.2 mg/kg (double the ED90) produced 90% neuromuscular block without any significant hemodynamic changes in patients with coronary artery disease 5
Neurosurgical patients: Vecuronium 0.1 mg/kg had no effect on intracranial pressure, cerebral perfusion pressure, or systemic hemodynamics 6
Critically ill patients: Multiple studies in ICU settings confirm no significant changes in heart rate, blood pressure, or intracranial pressure with vecuronium bolus administration 4
Mechanism of Hemodynamic Neutrality
Vecuronium lacks the vagolytic properties of pancuronium and does not cause histamine release like atracurium or d-tubocurarine. 4, 7 This explains its cardiovascular stability across a wide dose range.
Important Clinical Caveats
Vecuronium provides no sedation, analgesia, or amnesia and must always be administered with appropriate sedatives and analgesics 7
Dose adjustments are required in patients with renal insufficiency (up to 35% renal excretion) or hepatic insufficiency (up to 50% biliary excretion) 4, 7
Vecuronium will not counteract hemodynamic changes produced by anesthetic agents, other drugs, or underlying pathophysiology 1
While vecuronium itself does not lower blood pressure, patients must still be adequately sedated and analgesed, as inadequate sedation with neuromuscular blockade can cause severe distress 4