Pancuronium

Pancuronium Bromide: A Powerful Muscle Relaxant for Medical Procedures

Pancuronium bromide is a potent non-depolarizing neuromuscular blocking agent used to facilitate muscle relaxation during surgical procedures and mechanical ventilation. It works by competitively inhibiting the nicotinic acetylcholine receptor at the neuromuscular junction, effectively blocking the action of acetylcholine and leading to muscle paralysis.

Uses in Medicine

Pancuronium is commonly used in conjunction with general anesthesia to aid in tracheal intubation and to provide skeletal muscle relaxation during surgery. It is also used in some states as part of the lethal injection protocol for euthanasia. The drug does not have sedative or analgesic effects, making it a specific choice for muscle relaxation.

How It Works

Pancuronium acts by blocking the binding of acetylcholine to the nicotinic receptors at the motor end-plate, which leads to muscle paralysis. This action is reversible with anticholinesterase agents such as pyridostigmine, neostigmine, and edrophonium.

Side Effects and Precautions

Common side effects include increased heart rate, excessive salivation, apnea, respiratory depression, rashes, flushing, and sweating. It is crucial to monitor patients closely for these side effects, especially in seriously ill patients who may experience prolonged weakness due to the drug’s long duration of action.

Clinical Use and Administration

Pancuronium bromide is available in sterile, isotonic solutions for injection. Each milliliter contains 1 mg of pancuronium bromide, along with sodium acetate, benzyl alcohol as a preservative, and sodium chloride for tonicity adjustment. The pH is maintained between 3.8 and 4.2.

Important Considerations

Pancuronium is contraindicated in patients known to be hypersensitive to the drug. It is also important to note that the drug’s elimination half-life is doubled, and plasma clearance is reduced by approximately 60% in patients with renal failure. This may require higher initial doses and longer recovery times in such patients.

By understanding the pharmacological actions and clinical uses of pancuronium bromide, healthcare professionals can effectively utilize this powerful muscle relaxant in various medical procedures.