Vecuronium Intubating Dose in Pediatric Patients
The recommended intubating dose of vecuronium for pediatric patients is 0.1 mg/kg IV, which provides satisfactory intubation conditions in 60-90 seconds with a duration of action of approximately 30-45 minutes. 1
Standard Intubating Dose
- Administer vecuronium 0.1 mg/kg IV for routine intubation in pediatric patients. 1
- This dose produces adequate muscle relaxation for endotracheal intubation within 60-90 seconds after administration. 1
- Duration of neuromuscular blockade is approximately 30-45 minutes and is dose-dependent. 1
Age-Specific Considerations
Infants Under 1 Year (>7 Weeks)
- Infants are moderately more sensitive to vecuronium on a mg/kg basis compared to adults. 2
- Recovery time is approximately 1.5 times longer than in adults. 2
- The same 0.1 mg/kg dose is appropriate, but expect prolonged duration of action. 2
Children 1-10 Years
- This age group may require slightly higher initial doses compared to adults. 2
- The ED95 in children aged 3-10 years is 81 ± 12 mcg/kg, which is higher than in neonates/infants (47 ± 11 mcg/kg) and adolescents (55 ± 12 mcg/kg). 3
- Despite higher ED95 values, the standard 0.1 mg/kg intubating dose remains appropriate. 1, 4
Older Children (10-16 Years)
- Dosage requirements are approximately the same as adults on a mg/kg basis. 2
- Standard 0.1 mg/kg dose is appropriate. 2
Neonates and Infants <7 Weeks
- Insufficient data exist to recommend vecuronium use in this population. 2
- Consider alternative neuromuscular blocking agents if rapid sequence intubation is required.
Alternative Dosing for Rapid Sequence Intubation
- Vecuronium is NOT the preferred agent for rapid sequence intubation in pediatric emergencies. 1
- If vecuronium must be used for RSI, consider 0.2 mg/kg IV, though satisfactory intubation conditions still require approximately 2 minutes. 1
- Rocuronium (>0.9 mg/kg) or succinylcholine are preferred for rapid sequence intubation when faster onset is required. 5, 6
Critical Safety Requirements
Mandatory Preparations Before Administration
- Ventilatory support is absolutely necessary during vecuronium administration. 1
- Personnel with advanced airway management skills must be present and prepared to respond immediately. 1
- Age-appropriate equipment for suctioning, oxygenation, intubation, and ventilation must be immediately available. 1
Essential Caveats
- Vecuronium provides ZERO sedation, analgesia, or amnesia. 1, 7
- Always co-administer appropriate sedatives and analgesics to prevent awareness. 7
- Atropine 0.02 mg/kg (minimum 0.1 mg, maximum 1 mg) should be considered before vecuronium in patients at risk for bradycardia. 1
Drug Interactions
- Flush IV tubing with saline before administering vecuronium after thiopental or other alkaline solutions to avoid precipitation. 1
- Inhalation anesthetics (enflurane, isoflurane) enhance vecuronium effects by 25-60%, requiring dose reduction. 7, 2
- Aminoglycosides and metronidazole potentiate neuromuscular blockade. 7
Comparison with Alternative Agents
Vecuronium vs. Rocuronium
- Rocuronium 0.6 mg/kg produces acceptable intubating conditions significantly faster (within 60 seconds) compared to vecuronium 0.1 mg/kg (120 seconds). 8
- Quality of intubating conditions is rated significantly better with rocuronium than vecuronium at the time of successful intubation. 8
- For rapid sequence intubation, rocuronium >0.9 mg/kg is preferred over vecuronium. 5, 6
Vecuronium vs. Succinylcholine
- Succinylcholine remains faster for emergency intubation but is contraindicated in malignant hyperthermia, neuromuscular disease, burns, crush injuries, and spinal cord injuries. 1
- When succinylcholine is contraindicated, rocuronium >0.9 mg/kg is preferred over vecuronium for RSI. 6
Special Populations Requiring Dose Adjustment
Renal Impairment
- Reduce maintenance dose frequency and use lower individual doses (0.01 mg/kg rather than 0.015 mg/kg) as 35% is renally excreted. 7, 2
- Elimination half-life is prolonged in renal failure. 7
Hepatic Impairment
Monitoring Recommendations
- Peripheral nerve stimulation monitoring is essential to guide dosing and avoid overdosing. 7
- Train-of-four (TOF) monitoring should be used to assess depth of blockade. 7
- Goal TOF ratio ≥0.9 before extubation. 7
Reversal
- Neostigmine 0.04 mg/kg with atropine 0.02 mg/kg when at least 4 responses to TOF are present. 7