vecuronium

Vecuronium bromide is a nondepolarizing neuromuscular blocking agent of the aminosteroid class used to produce skeletal muscle relaxation during anesthesia and endotracheal intubation, and to facilitate mechanical ventilation. It acts as a competitive antagonist at nicotinic acetylcholine receptors at the motor endplate, preventing depolarization and resulting in flaccid paralysis without affecting consciousness or analgesia.

Administered intravenously, vecuronium has an onset of 2–3 minutes and a duration of approximately 25–40 minutes, depending on dose and patient factors. It is primarily hepatically metabolized with biliary excretion; renal clearance plays a minor role. In hepatic impairment or extreme obesity, duration may be prolonged; in MG or neuromuscular disease, increased sensitivity may occur. The drug is not active orally.

Reversal of blockade is achieved with acetylcholinesterase inhibitors such as neostigmine or edrophonium, typically given with an antimuscarinic agent to counteract muscarinic side effects; sugammadex provides a selective reversal by encapsulating the aminosteroid molecule. Clinically, vecuronium is valued for cardiovascular stability and relatively low histamine release compared with some other muscle relaxants.

Common interactions include potentiation by other neuromuscular blocking agents (eg, aminoglycoside antibiotics, calcium channel blockers, magnesium sulfate, volatile anesthetics). Adverse effects may include prolonged neuromuscular blockade in hepatic disease, anaphylaxis rare, and hypersensitivity.

Vecuronium has been marketed under various brand names since the 1970s; it is widely used for surgical anesthesia and critical care. Like other nondepolarizing agents, it does not affect consciousness or pain control; adequate anesthesia must be ensured.