vecuronium bromide


Summary: Monoquaternary homolog of PANCURONIUM. A non-depolarizing neuromuscular blocking agent with shorter duration of action than pancuronium. Its lack of significant cardiovascular effects and lack of dependence on good kidney function for elimination as well as its short duration of action and easy reversibility provide advantages over, or alternatives to, other established neuromuscular blocking agents.

Top Publications

  1. Goodwin M, Pandit J, Hames K, Popat M, Yentis S. The effect of neuromuscular blockade on the efficiency of mask ventilation of the lungs. Anaesthesia. 2003;58:60-3 pubmed
    ..47 (0.13)] and after [0.45 (0.13)] neuromuscular blockade. We conclude that neuromuscular blockade does not affect the efficiency of mask ventilation in patients with normal airways. ..
  2. Jooste E, Klafter F, Hirshman C, Emala C. A mechanism for rapacuronium-induced bronchospasm: M2 muscarinic receptor antagonism. Anesthesiology. 2003;98:906-11 pubmed
  3. Wang H, Zhang Y, Li S. The effect of local anesthetics on the inhibition of adult muscle-type nicotinic acetylcholine receptors by nondepolarizing muscle relaxants. Eur J Pharmacol. 2010;630:29-33 pubmed publisher
  4. Yoshida A, Itoh Y, Nagaya K, Takino K, Sugawara J, Murakami T, et al. Prolonged relaxant effects of vecuronium in patients with deliberate hypermagnesemia: time for caution in cesarean section. J Anesth. 2006;20:33-5 pubmed
    ..Our cases underscore the need for anesthesiologists as well as obstetricians to be aware of the prolongation of the action of nondepolarizing muscle relaxants as a result of magnesium treatment. ..
  5. Wang H, Yang B, HAN G, Li S. Potency of nondepolarizing muscle relaxants on muscle-type acetylcholine receptors in denervated mouse skeletal muscle. Acta Pharmacol Sin. 2010;31:1541-6 pubmed publisher
    ..The NDMR doses required to achieve satisfactory clinical effects differ at different times after muscle denervation. ..
  6. Paul M, Kindler C, Fokt R, Dresser M, Dipp N, Yost C. The potency of new muscle relaxants on recombinant muscle-type acetylcholine receptors. Anesth Analg. 2002;94:597-603; table of contents pubmed
  7. Jooste E, Sharma A, Zhang Y, Emala C. Rapacuronium augments acetylcholine-induced bronchoconstriction via positive allosteric interactions at the M3 muscarinic receptor. Anesthesiology. 2005;103:1195-203 pubmed
    ..These findings establish novel parameters that should be considered in the evaluation of airway safety of any newly synthesized neuromuscular blocking agents considered for clinical practice. ..
  8. Kindler C, Verotta D, Gray A, Gropper M, Yost C. Additive inhibition of nicotinic acetylcholine receptors by corticosteroids and the neuromuscular blocking drug vecuronium. Anesthesiology. 2000;92:821-32 pubmed
    ..The enhanced neuromuscular blockade produced when corticosteroids are combined with vecuronium may augment pharmacologic denervation and contribute to the pathophysiology of prolonged weakness observed in some critically ill patients. ..
  9. Wang H, Yang B, Xu Y, Yan T, Li S. Different magnitude of resistance to nondepolarizing muscle relaxants in the denervated mouse skeletal muscle. Acta Pharmacol Sin. 2010;31:399-404 pubmed publisher
    ..3 vs 33.5 nmol/L, P<0.05). Magnitude differences of resistance to different NDMRs caused by denervation are associated with distinct potencies of NDMRs at nAChR subtypes. ..

More Information


  1. Starretz Hacham O, Sofer S, Lifshitz M. Strychnine intoxication in a child. Isr Med Assoc J. 2003;5:531-2 pubmed
  2. Nitahara K, Kornak P, Nagashima H, Vizi E, Foldes F, Dan K. Adenosine potentiation of neuromuscular blocking agents in guinea-pigs. Br J Anaesth. 2000;84:245-7 pubmed
    ..05). We conclude that continuous infusion of adenosine 0.1 mg kg-1 min-1 potentiated the effects of neuromuscular blocking agents in this in vivo guinea-pig preparation. ..
  3. Kotani N, Hashimoto H, Sessler D, Muraoka M, Hashiba E, Kubota T, et al. Supplemental intraoperative oxygen augments antimicrobial and proinflammatory responses of alveolar macrophages. Anesthesiology. 2000;93:15-25 pubmed
    ..These data therefore suggest that intraoperative inhalation of 100% oxygen augments antimicrobial and proinflammatory responses in alveolar macrophages during anesthesia and surgery. ..
  4. Sanchez Palacios A, Ortiz Ponce M, Rodriguez Perez A, Schamann Medina F, García Marrero J. Modification of mediators of immune reaction after general anaesthesia. Allergol Immunopathol (Madr). 2004;32:352-60 pubmed
    ..In our setting and in our patients, the three myorelaxants produced immunosuppression of immune response mediators. The present study confirms that tests for allergy to myorelaxants are not indicated in the preoperative period. ..
  5. Liu J, Shen J, Li L, Chang Y. [Effects of fentanyl on cytokines and MDA during cardiopulmonary bypass in patients undergoing valve replacement]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2005;30:80-3 pubmed
  6. Ohsone J, Yamakage M, Murouchi T. [Reversal of neuromuscular blockade and complications of remaining blocking effect]. Masui. 2008;57:838-44 pubmed
    ..PhaseIII trials in Japan as well as Europe and the US have just been finished, and it is expected to be used clinically in the near future. ..
  7. Suzuki T, Masaki G, Ogawa S. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. Br J Anaesth. 2006;97:160-3 pubmed
    ..9 (2.0, 3.0-10.7) min]. Early reversal after neostigmine is prompt; however, recovery to a TOF ratio of 0.9 is slow in overweight and obese patients when vecuronium is dosed on the basis of the patient's RBW. ..
  8. Miguel R, Witkowski T, Nagashima H, Fragen R, Bartkowski R, Foldes F, et al. Evaluation of neuromuscular and cardiovascular effects of two doses of rapacuronium (ORG 9487) versus mivacurium and succinylcholine. Anesthesiology. 1999;91:1648-54 pubmed
    ..Although succinylcholine continued to show the shortest duration, 1.5 mg/kg rapacuronium used a rapid onset and a relatively short duration and may be considered an alternative to succinylcholine. ..
  9. Blunk J, Seifert F, Schmelz M, Reeh P, Koppert W. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol. 2003;20:245-53 pubmed
    ..The algogenic effect of aminosteroidal neuromuscular blocking drugs can be attributed to a direct activation of C-nociceptors. ..
  10. Eriksson L, Sundman E, Olsson R, Nilsson L, Witt H, Ekberg O, et al. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology. 1997;87:1035-43 pubmed
    ..90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle. ..
  11. Kopman A, Lien C, Naguib M. Determining the potency of neuromuscular blockers: are traditional methods flawed?. Br J Anaesth. 2010;104:705-10 pubmed publisher
    ..The CL for the ED(95), regardless of how it is calculated, are so wide that this parameter must be viewed, at best, as an approximation. ..
  12. Ruiz P, Chartrand D. The effect of isoflurane 0.6% on respiratory mechanics in anesthetized-paralyzed humans is not increased at concentrations of 0.9% and 1.2%. Can J Anaesth. 2003;50:67-70 pubmed
    ..2) compared to E(L0.6,) 12.37 +/- 5.72 and 13.52 +/- 5.64 cm H(2)O.L(-1), respectively. Isoflurane concentrations between 0.6-1.2% are not associated to a dose-dependent effect on respiratory mechanics. ..
  13. Steinberg D. [Interaction between vecuronium and atracurium revisited by adapting an alternative method]. Rev Esp Anestesiol Reanim. 2004;51:583-8 pubmed
    ..The alternative method presented for analyzing the potency of the individual components of the vecuronium-atracurium interaction demonstrated that their effect is greater after combination and definitively synergistic. ..
  14. Ciftci F, Pocan S, Karadayi K, Gulecek O. Local versus general anesthesia for external dacryocystorhinostomy in young patients. Ophthalmic Plast Reconstr Surg. 2005;21:201-6 pubmed
    ..Local anesthesia in young patients undergoing external DCR is a good alternative because it is cost-effective and it eliminates the complications of general anesthesia. ..
  15. Suzuki T, Nakamura T, Saeki S, Ogawa S. Vecuronium-induced neuromuscular blockade in a patient with cerebral palsy and hemiplegia. Anesth Analg. 2000;91:492-3 pubmed
    ..A remarkable resistance to vecuronium was observed in the hemiplegia side compared with cerebral palsy side. Complete recovery from neuromuscular block should be assessed in the cerebral palsy side that shows a delayed recovery. ..
  16. Saitoh Y, Toyooka H, Amaha K. Relationship between post-tetanic twitch and single twitch response after administration of vecuronium. Br J Anaesth. 1993;71:443-4 pubmed
    ..These results are consistent with the view that PTT reflects prejunctional block, whilst the single twitch response is indicative of postjunctional block. ..
  17. Alkhazrajy W, Khorasanee A, Russell W. Muscle weakness after muscle relaxants: an audit of clinical practice. Anaesth Intensive Care. 2004;32:256-9 pubmed
    ..01). These results suggest that in usual clinical practice at our institution, female patients are more likely to have residual weakness after muscle relaxants. ..
  18. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24:29-35 pubmed publisher
    ..Because of these properties, sugammadex has the potential to become a very useful drug for the management of neuromuscular blockade. ..
  19. Rhoney D, Murry K. National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. J Intensive Care Med. 2003;18:139-45 pubmed
    ..Vecuronium was prescribed more routinely than pancuronium. The number of institutions utilizing protocols for any of these agents was low; instead, decisions were based on clinician preference. ..
  20. Lapeyre G, Chevreaud C, Manel J, Mialhe C, Laxenaire M. [Comparison of the action kinetics of alcuronium and vecuronium by electromyographic monitoring]. Ann Fr Anesth Reanim. 1988;7:3-7 pubmed
    ..36 +/- 1.33%) than in the alcuronium group (T1min = 4.36 +/- 5.08%); it occurred significantly more quickly (p less than 0.001) with vecuronium (139 +/- 48 s) than with alcuronium (316 +/- 133 s).(ABSTRACT TRUNCATED AT 250 WORDS)..
  21. Brinkmann M, Günnicker M, Freund U, Schieffer M, Peters J. [Histamine plasma concentration and cardiovascular effects of non-depolarizing muscle relaxants: comparison of atracurium, vecuronium, pancuronium and pipecuronium in coronary surgical patients at risk]. Anasthesiol Intensivmed Notfallmed Schmerzther. 1998;33:362-6 pubmed
    ..If an increase in heart rate appears beneficial Pancuronium may be advantageous. ..
  22. Butler P. Comment on Matsota et al. Paediatr Anaesth. 2003;13:643; author reply 643 pubmed
  23. Ramkumar V, Umesh G, Philip F. Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189-94 pubmed publisher
    ..We compared the conventional preoxygenation technique (group C) with 20º head-up tilt (group H) and 5 cmH(2)O PEEP (group P) in non-obese individuals for non-hypoxic apnea duration...
  24. Prielipp R, Coursin D, Scuderi P, Bowton D, Ford S, Cardenas V, et al. Comparison of the infusion requirements and recovery profiles of vecuronium and cisatracurium 51W89 in intensive care unit patients. Anesth Analg. 1995;81:3-12 pubmed
    ..In addition, routine neuromuscular monitoring was not sufficient to eliminate prolonged recovery and myopathy in ICU patients. ..
  25. Suzuki H, Hashimoto Y, Hanaoka K, Amaki Y, Kobayashi T, Yamamura H. [A comparison between neuromuscular blocking effects of pipecuronium and vecuronium; a double blind controlled study in collaboration with 5 departments of anesthesiology]. Masui. 1994;43:1583-9 pubmed
    Neuromuscular blocking effects of pipecuronium bromide 0.04 were compared those of vecuronium bromide 0.08 in a double blind study...
  26. Gazzanelli S, Vari A, Tarquini S, Fermariello A, Caputo M, Almansour M, et al. [Monitoring of consciousness with BIS during induction of anesthesia. Which muscle relaxant?]. G Chir. 2005;26:163-9 pubmed
    ..The BIS-index data show that an opiate as Fentanyl is advisable with associations Cisatracurium/Propofol or Vecuronium/Propofol. It is possible to use in these cases a drip infusion to avoid the risk of awareness during intubation. ..
  27. Tassonyi E, Fathi M, Hughes G, Chiodini F, Bertrand D, Muller D, et al. Cerebrospinal fluid concentrations of atracurium, laudanosine and vecuronium following clinical subarachnoid hemorrhage. Acta Anaesthesiol Scand. 2002;46:1236-41 pubmed
    ..Vecuronium was not found in any CSF sample. Significant concentrations of atracurium and laudanosine but not of vecuronium were detected in the CSF of patients during and immediately after intracranial aneurysm surgery. ..
  28. Nakada J, Nishira M, Hosoda R, Funaki K, Takahashi S, Matsura T, et al. Priming with rocuronium or vecuronium prevents remifentanil-mediated muscle rigidity and difficult ventilation. J Anesth. 2009;23:323-8 pubmed publisher
    ..6%) in group D developed some difficulty with ventilation. The present study showed that priming with rocuronium or vecuronium reduced the incidence of difficult ventilation by avoiding the muscle rigidity caused by remifentanil. ..
  29. Hack H. Use of the Esophageal Doppler Machine to help guide the intraoperative management of two children with pheochromocytoma. Paediatr Anaesth. 2006;16:867-76 pubmed
    ..The advantages of such a technique compared with more invasive monitors are discussed. ..
  30. Cangemi C. Administration of general anesthesia for outpatient orthognathic surgical procedures. J Oral Maxillofac Surg. 2011;69:798-807 pubmed publisher
    ..Anesthetic techniques and agents allowing multiple orthognathic procedures to be performed in the outpatient setting are described. ..
  31. Bohrer H, Schmidt H, Bach A, Martin E, Kohl B, Bolsen K, et al. Inhibition of hepatic microsomal drug metabolism by atracurium administration in the rat. Pharmacol Toxicol. 1993;73:137-41 pubmed
    ..Atracurium influences hepatic P450, although it is predominantly degraded in extrahepatic tissues. Further studies are needed to evaluate the contribution of the major metabolite laudanosine to this inhibitory action. ..
  32. Canbay O, Kose E, Celebi N, Karagoz A, Ozgen S. Anesthesia for congenital insensitivity to pain with anhidrosis. Paediatr Anaesth. 2007;17:190-2 pubmed
  33. Ortiz J. [Utility of double burst stimulation in the detection of residual neuromuscular blockade]. Rev Esp Anestesiol Reanim. 1999;46:71-4 pubmed
    ..The most reliable index of recovery from neuromuscular blockade is the TR obtained by electromyographic monitoring. ..
  34. Ramirez J, Sprung J, Keegan M, Hall B, Bourke D. Neostigmine-induced prolonged neuromuscular blockade in a patient with atypical pseudocholinesterase. J Clin Anesth. 2005;17:221-4 pubmed
    ..In this report, we discuss drug interactions, phase II block, and the importance of timely neuromuscular monitoring. ..
  35. Stuth E, Stucke A, Setlock M. Another possible mechanism for bronchospasm after rapacuronium. Anesthesiology. 2002;96:1528-9 pubmed
  36. Tanaka T, Yamashita H, Ishii H, Fukuda K. [Anesthetic management for an infant with tetralogy of fallot with absent pulmonary valve]. Masui. 2005;54:169-71 pubmed
    ..Weaning from CPB was easy and postoperative course was uneventful with mild pulmonary hypertension. In the cases predisposed to right ventricular failure like TOF/APV, olprinone may be useful. ..
  37. Kim K, Cheong M, Jeon J, Lee J, Shim J. The dose effect of ephedrine on the onset time of vecuronium. Anesth Analg. 2003;96:1042-6, table of contents pubmed
    ..Ephedrine 70 microg/kg given before the induction of anesthesia improved tracheal intubating conditions at 2 min after vecuronium by increased cardiac output without significant adverse hemodynamic effects. ..
  38. Saitoh Y, Kaneda K, Tokunaga Y, Murakawa M. Infusion of amino acid enriched solution hastens recovery from neuromuscular block caused by vecuronium. Br J Anaesth. 2001;86:814-21 pubmed
    ..05). Infusion of amino acid enriched solution hastens recovery from neuromuscular block. ..
  39. van der Lee R, Jebbink L, van Herpen T, d Haens E, Bierhuizen J, van Lingen R. Feasibility of monitoring stress using skin conduction measurements during intubation of newborns. Eur J Pediatr. 2016;175:237-43 pubmed publisher
    ..Premedicated newborns display significant interindividual variation in skin conductance measurements during an intubation procedure. Neuromuscular blockade causes skin conductance measurements to disappear completely. ..
  40. Saarnivaara L, Klemola U, Lindgren L. QT interval of the ECG, heart rate and arterial pressure using five non-depolarizing muscle relaxants for intubation. Acta Anaesthesiol Scand. 1988;32:623-8 pubmed
    ..The mean control values of the heart rate were between 80 and 90 b.p.m. in the atropine-treated groups and between 70 and 80 b.p.m. in the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)..
  41. Asai T, Shingu K. Airway management of a patient with tracheal stenosis for surgery in the prone position. Can J Anaesth. 2004;51:733-6 pubmed
    ..Should the trachea be extubated accidentally, it may be re-intubated through the laryngeal mask and ventilation may be possible through the laryngeal mask or the exchange catheter. ..
  42. Wight W, Wright P. Pharmacokinetics and pharmacodynamics of rapacuronium bromide. Clin Pharmacokinet. 2002;41:1059-76 pubmed
    ..Rapacuronium has been withdrawn from sale because of this adverse effect, and its future availability is uncertain. ..
  43. Tripathi M, Pandey M. A randomized controlled double blind study on quick intubation regimen using vecuronium priming infusion technique with the use of patient controlled analgesia pump vs bolus priming technique. Indian J Med Res. 2005;122:319-23 pubmed
    ..PCA pump regimen for vecuronium priming infusion significantly shortened the onset of intubation. Side effects from the smaller priming dose by bolus were not seen in priming infusion regimen. ..
  44. Kim W, Lee J, Lee S, Park M, Park S, Seo D, et al. Comparison of motor-evoked potentials monitoring in response to transcranial electrical stimulation in subjects undergoing neurosurgery with partial vs no neuromuscular block. Br J Anaesth. 2013;110:567-76 pubmed publisher
    ..Other parameters were not different. If NMB is used during MEP monitoring, a target T(2)/Tc of 0.5 is recommended. In terms of the MEP amplitude and variability, no NMB was more desirable than any level of partial NMB. ..
  45. Jonsson M, Kim C, Yamamoto Y, Runold M, Lindahl S, Eriksson L. Atracurium and vecuronium block nicotine-induced carotid body chemoreceptor responses. Acta Anaesthesiol Scand. 2002;46:488-94 pubmed
    ..05). Finally, after wash-out the chemoreceptor responses to nicotine had fully recovered in both groups. Atracurium and vecuronium in equipotent concentrations block nicotine-induced chemoreceptor responses of the carotid body. ..
  46. Lim R. Rapacuronium: premarket drug evaluation can be very effective for the identification of drug risks. Anesth Analg. 2003;96:631-2 pubmed
  47. Igarashi A, Amagasa S, Horikawa H, Shirahata M. Vecuronium directly inhibits hypoxic neurotransmission of the rat carotid body. Anesth Analg. 2002;94:117-22, table of contents pubmed
    ..The results indicate that vecuronium significantly reduces carotid body neural responses to hypoxia, acetylcholine, and nicotine by inhibiting neuronal nicotinic receptors in the carotid body. ..
  48. Hayes A, Mirakhur R, Breslin D, Reid J, McCourt K. Postoperative residual block after intermediate-acting neuromuscular blocking drugs. Anaesthesia. 2001;56:312-8 pubmed
    ..Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward. ..
  49. Sadleir P, Clarke R, Bunning D, Platt P. Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth. 2013;110:981-7 pubmed publisher
    ..Cisatracurium had the lowest rate of cross-reactivity in patients who had previously suffered anaphylaxis to rocuronium or vecuronium. ..
  50. Forstmann V, Schuh F. [Onset of the effect and intubation conditions following atracurium, verocuronium and suxamethonium]. Anaesthesist. 1988;37:311-5 pubmed
    ..abstract truncated at 250 words) ..
  51. Purohit P, Tate R, Pow E, Hill D, Connolly J. The role of the amino acid residue at alpha1:189 in the binding of neuromuscular blocking agents to mouse and human muscle nicotinic acetylcholine receptors. Br J Pharmacol. 2007;150:920-31 pubmed
    ..In contrast, these non-conservative mutations had little effect on EC(50) values. This suggests that the AChR agonist binding site has a robust functional architecture, possibly as a result of evolutionary 'reinforcement'. ..
  52. Schneider G. [Muscle relaxants in the ICU]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2009;44:358-64; quiz 366, 379 pubmed publisher
    ..In ICU patients, neuromuscular monitoring should be applied. Prolonged action and critical illness neuropathy are the most prominent side effects of neuromuscular blockade. ..
  53. Morishima T, Sobue K, Tanaka S, So M, Arima H, Ando H, et al. Sevoflurane for general anaesthetic management in a patient with Larsen syndrome. Paediatr Anaesth. 2004;14:194-5 pubmed