Names and pronunciation
(pan-kyoo-roe′nee-um)
PDF page 1017
Loading InternPractice…
Drug reference
(pan-kyoo-roe′nee-um)
PDF page 1017
Func. class.: Neuromuscular blocker (nondepolarizing)
PDF page 1017
Chem. class.: Synthetic curariform
PDF page 1017
ACTION: Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine
PDF page 1017
USES: Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation, surgery, or general anesthesia
PDF page 1017
CONTRAINDICATIONS: Hyper sensitivity to bromide ion Precautions: Pregnancy, breastfeed- ing, children <2 yr, neuromuscular/ cardiac/renal/hepatic disease, electro- lyte imbalances, dehydration, previous anaphylactic reactions (other neuro- muscular blockers), respiratory insufficiency
PDF page 1017
Black Box Warning: Requires an experi- enced clinician
PDF page 1017
SIDE EFFECTS CNS: Prolonged neuromuscular blockade CV: Bradycardia; tachycardia; increased, decreased B/P; ventricular extrasystoles, edema, hypertension EENT: Increased secretions INTEG: Rash, flushing, pruritus, urti- caria, sweating, salivation MS: Weakness to prolonged skeletal muscle relaxation RESP: Prolonged apnea, bronchospasm, cyanosis, respiratory depression, dyspnea SYST: Anaphylaxis
PDF pages 1017, 1018
INTERACTIONS Increase: dysrhythmias—theophylline Increase: neuromuscular blockade— aminoglycosides, clindamycin, enflu- rane, isoflurane, lincomycin, lithium, local anesthetics, opioid analgesics, poly- myxin antiinfectives, quiNIDine, thiazides Drug/Lab Test Decrease: cholinesterase
PDF page 1018
TREATMENT OF OVERDOSE: Neostigmine, atropine, monitor VS; may require mechanical ventilation HIGH ALERT
PDF page 1018
DOSAGE AND ROUTES Neuromuscular blockade during surgery • Adult/child/infant >1 mo: IV 0.04-0.1 mg/kg initially or 0.05 mg/kg after initial dose of succinylcholine; maintenance 0.01 mg/kg 60-100 min after initial dose, then 0.01 mg/kg q25-60min as needed Endotracheal intubation Adult/adolescent/infant: IV 0.06-0.1 mg/kg/dose, onset of intubating 2-3 min Neuromuscular blockade during mechanical ventilation Adult: IV 0.05-0.1 mg/kg/dose as needed based on twitch response Child/adolescent: IV 0.05-0.15 mg/kg/ dose q4-6hr as needed
PDF page 1017
Available forms: Inj 1, 2 mg/mL
PDF page 1017
Administer: Direct IV route • May be given undiluted over 1-2 min (1 mg/mL [10-mL vial], 2 mg/mL [2-, 5-mL vial]) Intermittent IV INFUSION route • Add 100 mg of product to 250 mL D5W, NS, LR (0.4 mg/mL) • Store in refrigerator; do not store in plastic; use only fresh sol • Reassurance if communication is dif- ficult during recovery from neuromuscu- lar blockade • Frequent (q2hr) instillation of artifi- cial tears, covering of eyes to prevent P drying of cornea Y-site compatibilities: Aminophylline, ceFAZolin, cefuroxime, cimetidine, DOBUTamine, DOPamine, EPINEPHrine, esmolol, fenoldopam, fentaNYL, flucon- azole, gentamicin, heparin, hydrocorti- sone, isoproterenol, levoFLOXacin, LORazepam, midazolam, morphine, nitroglycerin, raNITIdine, trimethoprim- sulfamethoxazole, vancomycin
PDF page 1017
Assess: • Respiratory recovery: decreased pa- ralysis of face, diaphragm, leg, arm, rest of body; allow to recover fully before neurologic assessment • Electrolyte imbalances (K, Mg); may lead to increased action of product • VS (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pat- tern of respirations, strength of hand grip • I&O ratio; check for urinary retention, frequency, hesitancy • Allergic reactions, anaphylaxis: rash, fever, respiratory distress, pruritus; prod- uct should be discontinued • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; breast milk excretion is unknown
PDF page 1018
Evaluate: • Therapeutic response: paralysis of jaw, eyelid, head, neck, rest of body
PDF page 1018
CLINICAL CONSIDERATIONS
PDF page 1018
PHARMACOKINETICS IV: Onset 3-5 min, dose dependent, peak 3-5 min; metabolized (small amounts), excreted in urine (unchanged), crosses placenta
PDF page 1018
• Adult/child/infant >1 mo: IV 0.04-0.1 mg/kg initially or 0.05 mg/kg after initial dose of succinylcholine; maintenance 0.01 mg/kg 60-100 min after initial dose, then 0.01 mg/kg q25-60min as needed Endotracheal intubation Adult/adolescent/infant: IV 0.06-0.1 mg/kg/dose, onset of intubating 2-3 min Neuromuscular blockade during mechanical ventilation Adult: IV 0.05-0.1 mg/kg/dose as needed based on twitch response Child/adolescent: IV 0.05-0.15 mg/kg/ dose q4-6hr as needed
PDF page 1017