Vecuronium
Norcuron
neuromuscular blockerIVOnset: 2–3 minutesDuration: 25–40 minutes (single dose)
Mechanism of Action
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)
- Neostigmine + glycopyrrolate (traditional reversal)
Clinical Pearls
- Intermediate duration, vagally neutral (unlike pancuronium)
- Active metabolite accumulates in renal/hepatic failure → prolonged paralysis
- ICU myopathy risk increases when combined with corticosteroids
- Not ideal for prolonged ICU use — cisatracurium preferred (organ-independent elimination)
- Traditional reversal with neostigmine/glycopyrrolate (cholinesterase inhibitor)
Mnemonic
💡 Vecuronium: Vagally neutral, intermediate duration, Vaguely like rocuronium
NBRC High-Yield
- Non-depolarizing NMB — intermediate duration
- Vagally neutral (no tachycardia)
- Active metabolite accumulates in liver/renal failure
- ICU myopathy risk with prolonged use + corticosteroids
- Reversal: neostigmine + glycopyrrolate or sugammadex