Pancuronium Bromide

• Skeletal muscle relaxation:
• As an adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery.
• Facilitation of mechanical ventilation:
• In intensive care units to maintain muscle paralysis in patients requiring controlled ventilation.
• Electroconvulsive therapy (ECT):
• To prevent musculoskeletal injury by inducing muscle relaxation.
• Other procedural muscle relaxation:
• Where muscle paralysis is necessary for diagnostic or therapeutic procedures.

• Route: Intravenous (IV) preferred; intramuscular (IM) can be used if IV access is not available.
• Adults:
• Initial dose: 0.04 to 0.1 mg/kg IV.
• Maintenance dose: 0.01 to 0.02 mg/kg IV every 40–60 minutes or continuous infusion at 0.6 to 1.2 mcg/kg/min.
• Pediatrics:
• Similar dosing to adults; careful titration recommended.
• Elderly:
• Initiate at the lower end of the dosing range due to increased sensitivity and decreased clearance.
• Special populations:
• Renal impairment: Dose reduction and prolonged dosing intervals advised because of reduced elimination.
• Hepatic impairment: Use with caution; dose adjustments may be necessary.
• Monitoring: Neuromuscular function monitoring is essential to avoid overdose or prolonged paralysis.

Pancuronium bromide is a non-depolarizing neuromuscular blocking agent that competitively binds to nicotinic acetylcholine receptors at the neuromuscular junction. By blocking acetylcholine from activating these receptors, it inhibits depolarization of the motor endplate, leading to skeletal muscle paralysis. This effect facilitates muscle relaxation during surgery or mechanical ventilation.

• Absorption: Administered IV or IM; rapid onset following IV administration.
• Distribution: Volume of distribution approximately 0.3–0.4 L/kg; does not cross the blood-brain barrier.
• Metabolism: Partially metabolized hepatically.
• Elimination: Mainly excreted unchanged by the kidneys (~85%).
• Half-life: 1.5 to 2.5 hours; prolonged in renal impairment.
• Onset of action: 2–3 minutes post-IV injection.
• Duration of action: 60–90 minutes per dose.

• Pregnancy: Category C (FDA). Animal studies have shown adverse effects at high doses; use only if clearly needed.
• Lactation: Unknown excretion in human milk; minimal systemic absorption suggests low risk; use with caution and monitor infant.

• Neuromuscular blocking agent, non-depolarizing muscle relaxant.

• Hypersensitivity to pancuronium or related compounds.
• Myasthenia gravis or other neuromuscular disorders with increased sensitivity.
• Conditions where muscle paralysis without adequate ventilation would be hazardous.
• Severe renal failure without dose adjustment and monitoring.

• Requires mechanical ventilation support due to respiratory paralysis.
• May cause tachycardia and hypertension; use cautiously in cardiac patients.
• Electrolyte abnormalities (hypokalemia, hypermagnesemia) potentiate effects.
• Monitor neuromuscular function continuously to avoid prolonged paralysis.
• Risk of anaphylaxis; be prepared to manage hypersensitivity reactions.

• Common: Muscle weakness, tachycardia, hypertension, dry mouth.
• Serious/Rare: Anaphylaxis, respiratory arrest, arrhythmias, bronchospasm.

• Enhanced neuromuscular blockade with inhaled anesthetics (e.g., halothane).
• Potentiation by aminoglycosides, tetracyclines, lithium, magnesium sulfate.
• Cholinesterase inhibitors (e.g., neostigmine) reverse blockade; timing is critical.
• CNS depressants may increase respiratory depression risk.

• Increased emphasis on neuromuscular monitoring to individualize dosing and reduce complications.
• Recognition of prolonged effects in renal impairment guides dosing adjustments.
• Preference for shorter-acting muscle relaxants in some clinical scenarios to improve recovery times.
• Use of newer reversal agents to enhance safety.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from light and freezing.
• Keep vial tightly closed.
• Do not freeze or expose to excessive heat.
• Keep out of reach of children.