Non-Depolarising Neuromuscular Blocking Agent (Long-Acting) Pregnancy: Use with caution

Pancuronium

Brand names: Pavulon

Adult dose

Dose: Intubation: 0.1 mg/kg; Maintenance: 0.01–0.02 mg/kg

Route: IV

Frequency: Bolus; as required

Max: Titrated to TOF

Long-acting NMB (90–120 min). Causes tachycardia and hypertension (vagolytic + sympathomimetic effects). Useful in ICU for prolonged muscle relaxation. Largely superseded for routine surgery.

Paediatric dose

Dose: 0.1 mg/kg

Route: IV

Frequency: As required

Max: Titrated to effect

Neonates more sensitive — use lower doses and TOF guidance. Still used in neonatal ICU in some centres.

Dose adjustments

Renal

Primarily renally excreted (80%) — markedly prolonged in renal failure. Avoid in severe renal impairment.

Hepatic

Prolonged in hepatic failure — reduce maintenance doses.

Paediatric weight-based calculator

Patient weight (kg)

Neonates more sensitive — use lower doses and TOF guidance. Still used in neonatal ICU in some centres.

Clinical pearls

Pancuronium IS an aminosteroidal NMB — reversible with sugammadex (2–4 mg/kg at TOF 1–2 twitches) or neostigmine + glycopyrrolate
Vagolytic tachycardia can be useful in bradycardic cardiac surgical patients
Avoid in renal failure — consider cisatracurium (Hofmann elimination, organ-independent)

Contraindications

Hypersensitivity to pancuronium or bromide
Tachycardia is undesirable (e.g. ischaemic heart disease)

Side effects

Tachycardia and hypertension (vagolytic)
Anaphylaxis (rare)
Prolonged paralysis in renal failure

Interactions

Volatile anaesthetics (potentiate)
Aminoglycosides (potentiate)
Magnesium (potentiate)
Tricyclic antidepressants (arrhythmia risk)

Monitoring

TOF monitoring
ECG (tachycardia)
Renal function

Reference: BNFc; BNF 90; Miller's Anaesthesia 9th Ed; AAGBI Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways