Pancuronium bromide is a non-depolarizing, steroidal neuromuscular blocking agent (NMBA) of intermediate duration. It acts as a competitive antagonist at the nicotinic acetylcholine receptors of the neuromuscular junction, leading to skeletal muscle paralysis. It is primarily used as an adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation. It has vagolytic properties leading to tachycardia.
Adult: Initial IV bolus: 0.04 to 0.1 mg/kg (average 0.08 mg/kg or 4-8 mg for a 70 kg adult) for intubation. Maintenance: 0.01 to 0.02 mg/kg every 60-100 minutes as needed. Continuous infusion is not common due to accumulation.
Note: For IV use only. Administer as a slow IV bolus over 30-60 seconds. Must be diluted in a compatible IV solution (e.g., 0.9% Sodium Chloride, 5% Dextrose) to desired concentration. Incompatible with alkaline solutions (e.g., Thiopentone). Ensure patient is adequately sedated and ventilated. Use a peripheral nerve stimulator to monitor depth of blockade and guide dosing.
Pancuronium is a competitive antagonist at the post-synaptic nicotinic acetylcholine receptors (nAChR) at the skeletal muscle neuromuscular junction. It binds to the alpha subunits of the receptor, preventing acetylcholine (ACh) from binding and depolarizing the motor endplate. This inhibition prevents the generation of an action potential, leading to flaccid paralysis of skeletal muscles. It has no effect on consciousness or pain perception.
Pregnancy: Category C: Animal studies have shown adverse effects. Use only if clearly needed, as it crosses the placenta. May cause neonatal flaccidity and respiratory depression. Monitor neonate closely.
Driving: Patient will be paralyzed and sedated. Warn against driving or operating machinery until full recovery from anesthesia and neuromuscular blockade is confirmed, which may be several hours post-procedure.
| Volatile Anesthetics (Isoflurane, Sevoflurane, Desflurane) | Potentiates neuromuscular blockade, reducing pancuronium requirement by 30-50%. | Major |
| Aminoglycosides (Gentamicin, Amikacin) | Potentiates blockade via pre-junctional and post-junctional actions. | Major |
| Magnesium Sulfate | Potentiates neuromuscular blockade. | Major |
| Calcium Channel Blockers (Verapamil, Diltiazem) | May enhance neuromuscular blockade. | Moderate |
| Lithium | Prolongs duration of blockade. | Moderate |
| Acetylcholinesterase Inhibitors (Neostigmine, Pyridostigmine) | Antagonizes neuromuscular blockade. Used for reversal. | Major (Therapeutic) |
| Succinylcholine | Prior use may potentiate or antagonize pancuronium's effect. | Moderate |
| Corticosteroids (Chronic use) | May cause resistance to non-depolarizing NMBAs. | Moderate |
| Phenytoin, Carbamazepine | May cause resistance to pancuronium, requiring higher doses. | Moderate |