[.
]
Action/Kinetics:
Competes for cholinergic receptors at the motor end plate and is antagonized by acetylcholinesterase inhibitors. Has no effect on consciousness, pain threshold, or cerebration; thus, use must be accompanied by adequate anesthesia.
Maximum time for blockade: 5 min following single doses of 70-85 mcg/kg.
Time to recovery to 25% of control: 30-175 min under balanced anesthesia following single doses of 70 mcg/kg.
t
1/2, distribution: 6.22 min (4.33 min in renal transplant clients);
t
1/2, elimination: 1.7 hr (4 hr in renal transplant clients). Increased plasma levels are seen in clients with impaired renal function. Metabolized in the liver; metabolites and unchanged drug eliminated in the urine.
Uses:
Adjunct to general anesthesia to provide relaxation of skeletal muscle during surgery. Skeletal muscle relaxation for ET intubation. Recommended for procedures lasting 90 or more minutes.
Contraindications:
Due to the long duration of action, do not use in myasthenia gravis or Eaton-Lambert syndrome, as low doses can lead to a profound effect. Clients undergoing cesarean section. Use of pipecuronium before succinylcholine in order to reduce side effects of succinylcholine. In those requiring prolonged mechanical ventilation in the ICU or prior to or following other nondepolarizing neuromuscular blocking agents.
Special Concerns:
Although the drug is used in infants and children, no information is available on maintenance dosing. Also, children 1-14 years of age under balanced or halothane anesthesia may be less sensitive to the drug than adults. Use with caution in clients with impaired renal function. The drug should be administered only if there are adequate facilities for intubation, artificial respiration, oxygen therapy, and administration of an antagonist. Obesity may prolong the duration of action. Conditions resulting in an increased volume of distribution (e.g., old age, edematous states, slower circulation time in CV disease) may cause a delay in the time of onset.
Side Effects:
Neuromuscular:
Prolongation of blockade including skeletal muscle paralysis resulting in respiratory insufficiency or apnea. Muscle atrophy, difficult intubation.
CV: Hypotension, bradycardia, hypertension, CVA, thrombosis, myocardial ischemia, atrial fibrillation, ventricular extrasystole.
CNS: Hypesthesia, CNS depression.
Respiratory: Dyspnea, respiratory depression, laryngismus, atelectasis.
Metabolic: Hypoglycemia, hyperkalemia, increased creatinine.
Miscellaneous: Rash, urticaria, anuria.
Overdose Management:
Symptoms:
Skeletal muscle paralysis including depressed respiration.
Treatment: Artificial respiration until effects of drug have worn off. Antagonize neuromuscular blockade by administration of neostigmine, 0.04 mg/kg. Do not use edrophonium.
Drug Interactions:
-
Aminoglycosides /
Intensity and duration of neuromuscular blockade
-
Bacitracin /
Intensity and duration of neuromuscular blockade
-
Colistin/Sodium colistimethate /
Intensity and duration of neuromuscular blockade
-
Enflurane /
Duration of action of pipecuronium
-
Halothane /
Duration of action of pipecuronium
-
Isoflurane /
Duration of action of pipecuronium
-
Magnesium salts /
Intensity of neuromuscular blockade when used for toxemia of pregnancy
-
Polymyxin B /
Intensity and duration of neuromuscular blockade
-
Quinidine /
Risk of recurrent paralysis
-
Tetracyclines /
Intensity and duration of neuromuscular blockade
How Supplied:
Powder for injection: 10 mg
Dosage
?IV Only
Adjunct to general anesthesia.
Adults: Initial dose may be based on the C
CR and the ideal body weight (see information provided by manufacturer). Dose is individualized. The dose range is 50-100 mcg/kg.
ET intubation using balanced anesthesia.
70-85 mcg/kg with halothane, isoflurane, or enflurane in clients with normal renal function who are not obese; duration of muscle relaxation is 1-2 hr using this dosage range.
Use following recovery from succinylcholine.
50 mcg/kg in clients with normal renal function who are not obese; duration of muscle relaxation using this dose is 45 min.
Maintenance.
Adults: 10-15 mcg/kg given at 25% recovery of control T
1 will provide muscle relaxation for an average of 50 min using balanced anesthesia; lower doses should be used in clients receiving inhalation anesthetics.
Pediatric: The duration of action in infants following a dose of 40 mcg/kg ranged from 10 to 44 min while the duration in children following a dose of 57 mcg/kg ranged from 18 to 52 min.
