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Non-Depolarising Neuromuscular Blocking Agent Pregnancy: Use with caution — does not cross placenta significantly at clinical doses

Vecuronium

Brand names: Norcuron

Adult dose

Dose: 0.08-0.1 mg/kg IV (intubation); 0.01-0.015 mg/kg maintenance
Route: Intravenous
Frequency: Bolus; infusion 0.8-1.4 micrograms/kg/min
Max: 0.1 mg/kg intubation dose
Onset: 2-3 minutes. Duration: 25-40 minutes. High-dose: 0.15-0.2 mg/kg for rapid onset (not as fast as suxamethonium or rocuronium high-dose)

Paediatric dose

Dose: 0.08-0.1 mg/kg IV mg/kg
Route: IV
Frequency: Bolus or infusion
Max: 0.1 mg/kg
Neonates may require less frequent dosing — reduced plasma clearance. Child: same mg/kg as adult

Dose adjustments

Renal

Use with caution in renal impairment — partly renally excreted; prolonged blockade possible

Hepatic

Reduce dose and use with caution in hepatic impairment — primarily biliary excretion

Paediatric weight-based calculator

Neonates may require less frequent dosing — reduced plasma clearance. Child: same mg/kg as adult

Clinical pearls

  • Reversible with sugammadex (2 mg/kg for moderate block, 4 mg/kg for deep block, 16 mg/kg for immediate reversal) — advantage over atracurium which requires anticholinesterase reversal
  • NMBA anaphylaxis: NMBAs are the most common cause of perioperative anaphylaxis (approximately 60%); cross-reactivity between NMBAs is approximately 70% — identify specific causative agent with skin testing
  • No histamine release unlike atracurium — better cardiovascular stability; preferred in patients at risk of bronchospasm or histamine-related reactions
  • Hepatic impairment: prolonged duration; consider atracurium instead
  • TOF monitoring: essential for safe use, especially in ICU or prolonged procedures

Contraindications

  • Use without airway management facilities

Side effects

  • Prolonged neuromuscular blockade (organ impairment)
  • Tachycardia (weak vagolytic effect)
  • Anaphylaxis (rare — NMBAs are the most common cause of anaphylaxis during anaesthesia)

Interactions

  • Volatile anaesthetics (potentiate blockade)
  • Aminoglycosides (enhance blockade)
  • Sugammadex (reversal — encapsulates vecuronium)
  • Neostigmine (reversal)

Monitoring

  • TOF neuromuscular monitoring
  • SpO2
  • Level of consciousness (awareness risk with NMBA without sedation)

Reference: BNFc; BNF 90; Norcuron SPC; AAGBI NAP6 Perioperative Anaphylaxis Report. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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