Pavulon

Pavulon (Pancuronium Bromide) is a nondepolarizing neuromuscular blocking agent used to facilitate tracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation. It acts by competing for cholinergic receptors at the motor end-plate, effectively inhibiting acetylcholine and inducing neuromuscular blockade.

Key Features

• Chemical Composition: Pancuronium bromide is an aminosteroid muscle relaxant, chemically designated as 2 ß, 16 ß – dipiperidino-5?-androstane­ 3?, 17-ß diol diacetate dimethobromide.
• Formulation: Each milliliter of Pavulon contains 1 mg or 2 mg of pancuronium bromide, 2 mg of sodium acetate, and 1% benzyl alcohol as a preservative. The solution is adjusted to isotonicity with sodium chloride and has a pH of 4, using acetic acid and/or sodium hydroxide.
• Indications: Pavulon is indicated as an adjunct to general anesthesia, particularly useful for facilitating tracheal intubation and providing skeletal muscle relaxation during surgical procedures or mechanical ventilation.
• Contraindications: It is contraindicated in patients known to be hypersensitive to the drug and in neonates due to the presence of benzyl alcohol.
• Dosage: The recommended dose for intubation is 0.06 to 0.1 mg/kg, with conditions satisfactory for intubation usually present within 2 to 3 minutes.
• Clinical Pharmacology: The duration of neuromuscular blockade produced by Pavulon is longer than that of vecuronium at initially equipotent doses. The ED95 (dose required to produce 95% suppression of muscle twitch response) is approximately 0.05 mg/kg under balanced anesthesia and 0.03 mg/kg under halothane anesthesia.
• Special Considerations: In patients with cirrhosis, the volume of distribution is increased, and plasma clearance is decreased, resulting in a longer elimination half-life. Similarly, in patients with biliary obstruction, plasma clearance is significantly reduced. In renal failure, the elimination half-life is doubled, and plasma clearance is reduced by approximately 60%.

Usage and Precautions

Pavulon should be administered by adequately trained individuals familiar with its actions, characteristics, and hazards. It should not be administered unless facilities for intubation are available. The drug is compatible in solution with various anesthetic agents but should be used with caution in patients with hepatic or biliary tract dysfunction.

Compatibility

Pavulon is compatible in solution with other anesthetic agents commonly used in surgical procedures. However, it is essential to ensure that the solution does not contain any substances that could interact negatively with the drug.

By understanding these key features and usage guidelines, healthcare professionals can effectively utilize Pavulon to manage neuromuscular blockade during surgical procedures.