Vecuronium bromide

How it works

It competitively antagonises nicotinic acetylcholine receptors at the neuromuscular junction, preventing acetylcholine-induced depolarisation and producing flaccid paralysis.

Prescribing in practice

• It causes paralysis without sedation or analgesia, so adequate concurrent anaesthesia or sedation is essential to avoid awareness during paralysis.
• Its effect is prolonged in hepatic and renal impairment, and block may be potentiated by aminoglycosides, magnesium, and volatile anaesthetics.
• Residual block must be excluded before extubation; reversal can be achieved with sugammadex or an anticholinesterase plus an antimuscarinic.

Monitoring

Monitor depth of neuromuscular block with a peripheral nerve stimulator and confirm adequate recovery before reversal and extubation.

Counselling the patient

• Reassure the patient that they will be anaesthetised and unaware while the muscle relaxant is acting.
• Advise the team that depth of block is guided by nerve stimulator monitoring.
• Note that recovery is confirmed before the breathing tube is removed.

Evidence & guidelines

Vecuronium is an established non-depolarising muscle relaxant in UK anaesthetic practice, with quantitative neuromuscular monitoring recommended to avoid residual paralysis.