Pancuronium
Vecuronium
Cisatracurium/Atracurium
Mivacrium
Rocuronium
100

pancuronium (pavulon) chemical classification

bisquaternary aminosteroid --> vagolytic properities

100

vecuronium (norcuron) & rocuronium (zemuron) chemical classification

aminosteroid

100

cisatracurium (nimbex) chemical classification

benzlisoquinolone

100

chemical classification of mivacurium (mivacron)

benzlisoquinolone

100

CV effects of vecuronium

essentially none

no histamine release

200

pancuronium (pavulon) 

dose

onset

duration

intubating dose 0.1mg/kg

onset 3-5 min

duration 60-90 minutes

*most common long-acting NMBD

200

vecuronium (norcuron)

dose

onset

duration

0.1 mg/kg

onset 3-5 minutes

duration 20-35 min

200

cisatracurium (nimbex)

dose

onset

duration

0.1 mg/kg

onset 3-5 min

duration 20-35 min

200

mivacurium (Mivacron)

dose

onset

duration

0.15 mg/kg

2-3 min onset with conditions less desirable

12-20 duration *only short-acting non-depolarizer

200

rocuronium (zemuron) 

dose

onset

duration

0.6 mg/kg or 1.2 mg/kg

*larger doses parallel onset of SCh but offset of pancuronium

onset= 3-5 min, 1-2 min

duration = 20-35 min

300

pancuronium (pavulon) metabolism

80% eliminated unchanged in urine


300

vecuronium (norcuron) metabolism

hepatic metabolism *principle organ of elimination

3-desacetlvecuronium 50-80% potent but rapidly converted to metabolite with 1/10 the effects

renal excretion

30% unchanged (70% metabolized in liver)

renal dysfunction - E1/2 time prolonged


repeated doses or infusion = cumulative effects

300

cisatracurium (nimbex) metabolism

Cis-isomer

recovery from infusion is not affected by time

**Degradation

Hoffman elimination

doesnt use specific plasma cholinesterases as much as atracurium

300

mivaron metabolism

3 stereoisomers

(Cis-Cis, *Cis-Trans, *Trans-Trans) *NM blocking ability

cleared by plasma cholinesterase

not currently on market

300

rocuronium (zemuron) metabolism

excreted unchanged in bile

*longer duration of action in liver failure and elderly due to decreased clearance and increased Vd

10-30% renal excretion, only marginally affected in renal failure

400

pancuronium (pavulon) CV effects

increase HR, MAP, CO due to vagal blockade

*mostly at SA Node, BP increase due to HR

direct SNS activation

*release of NE presynaptically, blockade of NE reuptake

No change in SVR or inotropy

No Histamine Release

400

acid base changes with vecuronium (norcuron)

prior to NMBD - no prolonged blockade

Respiratory acidosis - following NMBD - prolongs blockade

*actively inversely proportional to bound drug... acidosis decreases the bound amount

*change in ionization at receptor increases attachment time

*concern with postop hypoventilation

400

cisatracurium (nimbex) in elderly and obese

elderly - slight delay (1 min) due to cardiac output

obese - duration of action prolonged if dosed at actual body weight due to volume of distribution

400

CV effects with mivacron

minimal effects

histamine release

*>3 * ED95... transient MAP drop

*more common with rapid, large doses

*MAP drop more in HTN patients than non HTN patients

400

CV effects of rocuronium (zemuron)

no histamine release

no cardiac effects - slight vagolytic effect??

500

alterations in metabolism with pancuronium

Renal failure: 30-50% decreased plasma clearance, 10-40% deasacetylpancuronium metabolite 1/2 active (by liver)


In liver disease: increased Vd, larger initial dose need, prolonged Elimination 1/2 time


in aging: decreased plasma clearance due to renal function

500

vecuronium (norcuron) in the elderly and pregnant patient

elderly - decreased VD (less muscle mass), decreased plasma clearance (less hepatic flow)

*single dose mechanics unchanged, delayed recovery with infusions

obstetrics

*insignificant effects to fetus, increased clearance in 3rd trimester, prolonged during during early postpartum (dose IBW)

500

cisatracurium (nimbex) CV effects

no histamine release

CV stable

500

Compared with LA NMBDs

similar onset of maximum blockade (except high dose roc)

approximately 1/3 duration of action

minimal/absent CV effects

antagonized by anticholinesterase drugs approx 20 min

500

Long Acting NMBDs

Intermediate Acting NMBDs

Short Acting NMBDs

Long- Pancuronium

Intermediate - cisatracurium, atracurium, vecuronium, rocuronium

Short - mivacurium