Vecuronium
Norcuron
Aminosteroid non-depolarizing neuromuscular blocker (intermediate-acting)
Competitive nicotinic ACh-receptor antagonist at the NMJ. Aminosteroid → reversible by sugammadex.
Indications
- •Intraoperative relaxation
- •Facilitation of intubation (slower than roc/sux)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Intubation | 0.08–0.1 mg/kg IV | 0.1 mg/kg IV |
| Maintenance | 0.01–0.015 mg/kg IV boluses or infusion 1 mcg/kg/min | — |
Pharmacokinetics
Onset 2–3 min. Duration 30–45 min. Hepatic + biliary (some renal) — active metabolite (3-desacetyl) accumulates in renal failure/ICU → prolonged block.
Hemodynamic effects
Essentially none (no histamine, no vagolysis) — very cardiostable.
Side effects
- !Prolonged block in hepatic/renal impairment (active metabolite)
- !Prolonged weakness in ICU (steroid myopathy risk with steroids)
Contraindications
- ×Known aminosteroid allergy
Reversal / antidote
Sugammadex (2–4 mg/kg by depth) or neostigmine + glycopyrrolate
Clinical pearls
- ★Most hemodynamically stable NMB (no histamine/vagal effects).
- ★Active 3-desacetyl metabolite → prolonged block in renal failure + prolonged ICU infusions.
- ★Reversible by sugammadex (aminosteroid).
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).
- Atracurium
Competitive nicotinic antagonist. Eliminated by HOFMANN elimination (spontaneous, temp/pH-dependent) + ester hydrolysis → organ-independent clearance.
- Pancuronium
Competitive nicotinic antagonist. Also blocks cardiac muscarinic receptors (vagolytic) → tachycardia.
- 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
