Neuromuscular block: vecuronium
Vecuronium is an intermediate acting nondepolarizing neuromuscular blocking agent of the steroidal compound variety. The initial intubating dose is 0.1-0.2 mg/kg followed by supplemantal doses of 0.02 mg/kg after intubation. Vecuronium undergoes approximately30-40% metabolism by the liver and is eliminated by the liver (50-60%) and kidney (40-50%). Roughly 12% gets converted to an active metabolite 3-desacetylvecuronium that has approximately 80% of the potency of vecuronium. In patients with renal failure, this metabolite can accumulate and is thought to be the cause of delayed recovery in ICU patients. Additionally, elimination half time is increased 24-56% in the setting of renal failure, duration is longer and more variable. Vecuronium is considered a long-acting agent in infants, due to their immature livers.