Vecuronium

How it works

It competitively antagonises acetylcholine at nicotinic receptors of the neuromuscular junction, preventing depolarisation and producing reversible skeletal muscle paralysis.

Prescribing in practice

• It causes complete respiratory paralysis and must only be used with controlled ventilation by clinicians skilled in airway management, ensuring adequate anaesthesia since it provides no sedation or analgesia.
• Block is prolonged in hepatic impairment, and is potentiated by aminoglycosides, magnesium, volatile anaesthetics and hypothermia.
• Confirm adequate recovery of neuromuscular function, using a reversal agent where appropriate, before extubation to avoid residual paralysis.

Monitoring

Monitor depth of neuromuscular blockade with a peripheral nerve stimulator and maintain continuous ventilatory and haemodynamic monitoring until full recovery.

Counselling the patient

• This medicine is given while you are asleep under anaesthesia to relax your muscles for surgery.
• You may feel mild muscle aches afterwards, which settle on their own.

Evidence & guidelines

Vecuronium is a long-established neuromuscular blocker with a well-defined profile described in the SPC and UK anaesthetic practice.