Yes

Neuromuscular Blocker Agent, Nondepolarizing

Drug of choice for neuromuscular blockade except in patients with renal failure, hepatic failure, or cardiovascular instability; produce skeletal muscle relaxation during surgery after induction of general anesthesia, increase pulmonary compliance during assisted respiration, facilitate endotracheal intubation, preferred muscle relaxant for neonatal cardiac patients, must provide artificial ventilation

C

Hypersensitivity to pancuronium, bromide, or any component

Ventilation must be supported during neuromuscular blockade. Electrolyte imbalance alters blockade. Use with caution in patients with myasthenia gravis or other neuromuscular diseases, pre-existing pulmonary, hepatic, renal disease, and in the elderly.

1% to 10%:

Cardiovascular: Elevation in pulse rate, elevated blood pressure, tachycardia, hypertension

Dermatologic: Rash, itching

Gastrointestinal: Excessive salivation

<1%: Skin flushing, edema, erythema, burning sensation along the vein, profound muscle weakness, wheezing, circulatory collapse, bronchospasm, hypersensitivity reaction

Causes of prolonged neuromuscular blockade:

Excessive drug administration

Cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal impairment)

Accumulation of active metabolites

Electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia, hypernatremia)

Hypothermia

Drug interactions

Increased sensitivity to muscle relaxants (eg, neuromuscular disorders such as myasthenia gravis or polymyositis)

Symptoms of overdose include apnea, respiratory depression, cardiovascular collapse; pyridostigmine, neostigmine, or edrophonium in conjunction with atropine will usually antagonize the action of pancuronium

Increased toxicity: Magnesium sulfate, furosemide can increase or decrease neuromuscular blockade (dose-dependent)

Prolonged neuromuscular blockade:

Inhaled anesthetics

Local anesthetics

Calcium channel blockers

Antiarrhythmics (eg, quinidine or procainamide)

Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin)

Immunosuppressants (eg, cyclosporine)

Refrigerate; however, is stable for up to 6 months at room temperature; I.V. form is incompatible when mixed with diazepam at a Y-site injection

Blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites

Peak effect: I.V.: Within 2-3 minutes

Duration: 40-60 minutes (dose dependent)

Metabolism: 30% to 45% in the liver

Half-life: 110 minutes

Elimination: In urine (55% to 70% as unchanged drug)

Based on ideal body weight in obese patients. I.V.:

Continuous I.V. infusions are not recommended due to case reports of prolonged paralysis

Dosing adjustment in renal impairment: Elimination half-life is doubled, plasma clearance is reduced and rate of recovery is sometimes much slower

Cl_cr 10-50 mL/minute: Administer 50% of normal dose

Cl_cr <10 mL/minute: Do not use

Dosing adjustment/comments in hepatic disease: Elimination half-life is doubled, plasma clearance is doubled, recovery time is prolonged, volume of distribution is increased (50%) and results in a slower onset, higher total dosage and prolongation of neuromuscular blockade

Patients with liver disease may develop slow resistance to nondepolarizing muscle relaxant; large doses may be required and problems may arise in antagonism

May be administered undiluted by rapid I.V. injection

Heart rate, blood pressure, assisted ventilation status; cardiac monitor, blood pressure monitor, and ventilator required

Does not alter the patient's state of consciousness; addition of sedation and analgesia are recommended; may be administered undiluted by rapid I.V. injection

Injection, as bromide: 1 mg/mL (10 mL); 2 mg/mL (2 mL, 5 mL)