Vecuronium

Vecuronium

File:Vecuronium.png
Clinical data
Pregnancy category	US: C (Risk not ruled out)
Routes of administration	Intravenous
ATC code	M03AC03 (WHO)
Pharmacokinetic data
Bioavailability	100% (IV)
Metabolism	liver 30%
Elimination half-life	51–80 minutes (longer with renal failure)
Excretion	Fecal (40-75%) and renal (30% as unchanged drug and metabolites)
Identifiers
IUPAC name [(2S,3S,5S,8R,9S,10S,13S,14S,16S,17S)- 17-acetyloxy-10,13-dimethyl-16-(1-methyl-3,4, 5,6-tetrahydro-2H-pyridin-1-yl)-2-(1-piperidyl)- 2,3,4,5,6,7,8,9,11,12,14,15,16,17-tetradecahydro- 1H-cyclopenta[a]phenanthren-3-yl] acetate
CAS Number	50700-72-6
PubChem CID	39765
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C34H57N2O4+
Molar mass	557.827 g/mol

Vecuronium bromide (trade name Norcuron) is a muscle relaxant in the category of non depolarising neuromuscular blocking agents. Vecuronium bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Although vecuronium bromide is often though of as a muscle relaxant, it may be more accurate to classify it as a paralyzing agent.

Clinical pharmacology

Vecuronium operates by competing for the cholinergic receptors at the motor end plate thereby exerting its muscle relaxing properties which are used adjunctively to general anesthesia. Under balanced anesthesia, the time to recovery to 25% of control (clinical duration) is approximately 25 to 40 minutes after injection and recovery is usually 95% complete approximately 45 to 65 minutes after injection of intubating dose. The neuromuscular blocking action of vecuronium is slightly enhanced in the presence of potent inhalation anesthetics. If vecuronium is first administered more than 5 minutes after the start of the inhalation of enflurane, isoflurane, or halothane, or when steady state has been achieved, the intubating dose of vecuronium may be decreased by approximately 15%.

Vecuronium is normally given at 0.08–0.1 mg/kg intravenously and its maintenance dose is usually between 0.02–0.03 mg/kg, but as with all other neuromuscular blocking agents, the doses need to be tailored for each individual patient.

Uses in popular culture

• Vecuronium is used in the episode "Need to Know" of the television show House, M.D. to paralyze a patient with uncontrollable muscle spasms. A similar usage is seen in the "Autopsy" episode of the same show in order to prevent unwanted shivering during a risky procedure.

• Vecuronium is also used by a doctor on Law & Order before extracting an organ on an alleged brain dead patient. McCoy catches it and uses it against the doctor on the stand to convict him of murder.

• Vecuronium is also used by terrorists in the video game Metal Gear Acid to sedate all of the passengers on an airplane, thus making them hostages.

• Dr. Luka Kovac is forcibly administered vecuronium by two prisoners in a botched attempt to escape from police custody in hospital in an episode of ER titled “21 Guns.”