pancuronium

Pancuronium is a long-acting, nondepolarizing neuromuscular blocking agent used to produce skeletal muscle relaxation during anesthesia and to facilitate tracheal intubation. It belongs to the aminosteroid class and acts by competitively antagonizing nicotinic acetylcholine receptors at the neuromuscular junction, thereby preventing depolarization and muscle contraction.

The onset of pancuronium after intravenous administration is typically about 2 to 3 minutes, with a duration of action around 60 to 90 minutes, depending on dose and patient factors. It is primarily cleared by hepatic metabolism, with renal excretion contributing to clearance; thus liver disease and advanced age can prolong its effects. It is used as part of general anesthesia and for controlled paralysis during mechanical ventilation, and its depth of blockade is monitored with neuromuscular monitoring techniques.

Adverse effects include potential tachycardia and mild increases in blood pressure due to vagolytic activity; it is less likely to cause histamine release than some older agents. Prolonged blockade can occur in patients with organ dysfunction or in the elderly, and careful dosing and monitoring are important to avoid respiratory compromise.

Reversal of pancuronium-induced blockade is achieved with acetylcholinesterase inhibitors such as neostigmine (usually given with an antimuscarinic agent like glycopyrrolate) or with the selective reversal agent sugammadex in settings where it is available and appropriate.