Non-depolarizing neuromuscular blocking agent. Competitive antagonist at nicotinic ACh receptors. Structurally similar to pancuronium but without vagolytic effects (no tachycardia).
Dosing
Adult
Intubation: 0.1–0.2 mg/kg IV. Maintenance: 0.01–0.015 mg/kg q20–40 min or 1–2 mcg/kg/min infusion
Indications
Intubation (maintenance paralysis, not RSI)
Facilitation of mechanical ventilation
ARDS management
Contraindications
Hypersensitivity to vecuronium
Prolonged block in liver or renal failure
Side effects
Prolonged paralysis (liver and renal failure — active metabolite 3-OH-vecuronium)
Minimal cardiovascular effects (vagally neutral)
Acute quadriplegic myopathy syndrome with prolonged ICU use and corticosteroids
Monitoring parameters
Train-of-four
Sedation and analgesia
Liver and renal function
Drug interactions
Aminoglycosides (potentiate block)
Corticosteroids with prolonged use → myopathy
Sugammadex can reverse (off-label — lower efficacy than for rocuronium)