FACILITATION OF ENDOTRACHEAL INTUBATION AND PROVISION OF MUSCLE RELAXATION IN GENERAL ANAESTHESIA DURING SURGICAL PROCEDURES
Adult:
Neonate:30-40 mcg/kg. Maintenance: 10-20 mcg/kg 4-6 hrly as necessary. 1 mth-18 yr: initially 60-100 mcg/kg, then 10-20 mcg/kg repeated as recquired.
Intramuscular
FACILITATION OF ENDOTRACHEAL INTUBATION AND PROVISION OF MUSCLE RELAXATION IN GENERAL ANAESTHESIA DURING SURGICAL PROCEDURES
Adult:
Initially, 50-100 mcg/kg. Maintenance: 10-20 mcg/kg. Can be administered undiluted by rapid IV inj.
Intramuscular
FACILITATE MECHANICAL VENTILATION IN INTENSIVE CARE
Adult:
Initially, 50-100 mcg/kg. Maintenance: 10-20 mcg/kg. Can be administered undiluted by rapid IV inj.
Precautions
Myasthenia gravis; severe electrolyte disorders; severe CV disease; pregnancy. Hepatic and renal function impairment. Hypothermia; jaundice; hypermagnesaemia, hypocalcaemia, hypokalaemia, hypoproteinaemia, acidosis, alkalosis, hypercalcemia. In obese patients, dose should be based on ideal body wt. Elderly; previous anaphylactic reactions to other neuromuscular-blocking agents. Burn patients (>30% of body) may be resistant to action for 5-70 days after injury. Demyelinating lesions, peripheral neuropathies, denervation, infection, muscle trauma, and DM may antagonise the neuromuscular blockade effects of drug. Neuromuscular diseases, acute intermittent porphyria, Eaton-Lambert syndrome. Maintain adequate airway and respiratory support during use.
Potentially Life-threatening
Adverse Drug Reactions
Tachycardia may occur due to vagal blockade and especially during light anaesthesia. May decrease intra-ocular pressure and induce miosis; excessive salivation; transient rashes and itching; wheezing; elevation in pulse rate, BP, cardiac output; erythema; burning sensation along vein; profound muscle weakness; bronchospasm; hypersensitivity reaction; acute quadriplegic myopathy syndrome, myositis ossificans.
Neuroleptanalgaesia may decrease neuromuscular activity. Action may be prolonged and/or potentiated by aminoglycoside antibiotics, lithium, diazepam, lidocaine (high dose), quinidine, tetracyclines, propranolol, thiamine (high dose), parenteral magnesium sulphate, MAOIs, quinine, protamine, carbamazepine, donepezil and phenytoin (if pancuronium is given concurrently for <1 wk). Action may be decreased by neostigmine, edrophonium, high-dose or long term corticosteroids, adrenaline (may also potentiate effect), azathioprine, theophylline (high doses), clindamycin, nifedipine, piperacillin, polymixins, verapamil, procainamide. Furosemide may increase or decrease effects. TCAs may increase risk of arrhythmias and hypotension during anaesthesia.
