Pancuronium
Pavulon
Aminosteroid non-depolarizing neuromuscular blocker (long-acting)
Competitive nicotinic antagonist. Also blocks cardiac muscarinic receptors (vagolytic) → tachycardia.
Indications
- •Long cases needing prolonged relaxation (less common now)
- •Historically part of lethal-injection protocols (not clinical)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Intubation | 0.08–0.1 mg/kg IV | — |
| Maintenance | 0.01 mg/kg boluses | — |
Pharmacokinetics
Onset 3–5 min. Long duration 60–100 min. Primarily RENAL elimination → markedly prolonged in renal failure.
Hemodynamic effects
Tachycardia + modest HTN (vagolytic + mild sympathetic stimulation).
Side effects
- !Tachycardia
- !Prolonged block in renal failure
- !Residual paralysis (long-acting)
Contraindications
- ×Renal failure (relative — accumulation)
- ×Tachycardia-sensitive cardiac disease
Reversal / antidote
Neostigmine + glycopyrrolate (sugammadex binds pancuronium only weakly — NOT a reliable reversal)
Clinical pearls
- ★Vagolytic → tachycardia is the signature effect (contrast with cardiostable vecuronium).
- ★Long-acting + renal elimination → residual-paralysis risk; largely displaced by intermediate agents.
Other drugs in Muscle Relaxants & Reversals
- Succinylcholine
Acetylcholine receptor agonist at the NMJ; sustained depolarization → fasciculations → flaccid paralysis. Hydrolyzed by plasma cholinesterase.
- Rocuronium
Competitive antagonist at the NMJ nicotinic receptor.
- Sugammadex
Encapsulates rocuronium > vecuronium > pancuronium in 1:1 complex. No effect on cisatracurium, atracurium, sux.
- Cisatracurium
Competitive antagonist at the post-synaptic nicotinic ACh receptor at the neuromuscular junction. Single cis-cis isomer of atracurium (4× more potent, lower laudanosine production).
- Vecuronium
Competitive nicotinic ACh-receptor antagonist at the NMJ. Aminosteroid → reversible by sugammadex.
- Atracurium
Competitive nicotinic antagonist. Eliminated by HOFMANN elimination (spontaneous, temp/pH-dependent) + ester hydrolysis → organ-independent clearance.
- Mivacurium
Competitive nicotinic antagonist. UNIQUE among non-depolarizers: metabolized by PLASMA CHOLINESTERASE (like succinylcholine) → shortest-acting NDMR.
Browse all classes: /reference/drugs
Suggested reading
- •Stoelting & Hines, Pharmacology & Physiology in Anesthetic Practice, 6e
- •Miller's Anesthesia, 9e
- •FDA package insert
