Indications
Pancuronium bromide is a muscle relaxant used in hospital during general anaesthesia. It relaxes the muscles so that a breathing tube can be placed in the windpipe, to make surgery easier, and to help patients on a breathing machine (ventilator) in intensive care.
How It Works
Pancuronium is a non-depolarising neuromuscular blocker. It blocks the receptors on muscles that respond to acetylcholine, the chemical messenger released by nerves. Without this signal, skeletal muscles, including the breathing muscles, relax and cannot contract. It does not cause sleep or relieve pain, so it is always given with anaesthetic and pain-relief medicines.
Dosage and Administration
Pancuronium is given only by an anaesthetist or trained critical care doctor as an injection into a vein, in a setting where breathing can be fully supported with a ventilator. The dose is based on body weight and the length of the procedure and is adjusted with nerve stimulator monitoring, as prescribed. Its effect can be reversed at the end of surgery with medicines such as Neostigmine given with an anticholinergic.
Interactions
Its effect is increased by inhaled anaesthetics, some antibiotics (Gentamicin and other aminoglycosides, Clindamycin, Polymyxins), Magnesium, Lithium, Quinidine, calcium channel blockers and some diuretics. Its effect may be reduced by long-term use of Phenytoin or Carbamazepine. It can raise heart rate, and care is needed with tricyclic antidepressants and other medicines that affect heart rhythm. Tell the doctor about all medicines.
Contraindications
- Allergy to Pancuronium or bromide.
- Situations where breathing cannot be supported mechanically.
- Used with care, or avoided, in people where a fast heart rate would be harmful.
Side Effects
Common effects include a faster heart rate and a rise in blood pressure. Prolonged muscle weakness can occur, especially after long use in intensive care or in people with kidney or liver disease. Increased saliva, rash and flushing may occur.
The medical team will act immediately on signs of a serious allergic reaction (sudden low blood pressure, wheezing, swelling or rash) or if breathing does not recover as expected after the procedure. Tell staff if you notice ongoing weakness after waking up.
Pregnancy and Lactation
It may be used during Caesarean section and other procedures in pregnancy when the anaesthetist judges it necessary. Effects on the newborn are usually small, but the baby is monitored. Breastfeeding can usually continue after the mother recovers from anaesthesia; follow the doctor’s advice.
Precautions and Warnings
Used with care in people with kidney or liver disease (effect lasts longer), myasthenia gravis or other nerve and muscle disorders (very sensitive), burns, low potassium, dehydration, acid base imbalance, obesity and heart disease. Body temperature and electrolytes are kept normal, and recovery of muscle function is checked before the breathing tube is removed.
Overdose
Overdose causes prolonged paralysis and inability to breathe. Breathing is supported with a ventilator until muscle function returns, and reversal medicines may be given by the anaesthetist.
Therapeutic Class
Non-depolarising neuromuscular blocking agent (skeletal muscle relaxant).
Storage
Store as directed on the pack, usually in a refrigerator at 2 to 8°C. Do not freeze. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.