Properties of neuromuscular blocking agents

Agent* Vecuronium Rocuronium Pancuronium Mivacurium Atracuriurn Cisatracurium Succinyicholine

Type (structure) Non- Non- Non- N o n - de po l ar i zin g Non- N o n - de po l ar i zin g Depolarizing
depolarizing depolarizing depolarizing depolarizing

Type (dura tion) I n t e r m e di a t e I n te r m e di a te Long Short I n t e r m e di a t e I n t e r m e di a t e U l t r a sh o r t

Potency - ED 95 0.04 0.30 0.07 0.08 0.21 0.04 to 0. 05 0.25 to 0. 30

(mg/kg)

Intubating dose 0.10 to 0. 20 0.60 to 1. 00 0.08 to 0. 12 0.20 0.50 to 0. 60 0.15 to 0. 20 0.60 to 1. 50

(mg/kg) (1.20 with RSII
dose)

Onset time (min) 3 to 4 1 to 2 2 to 3 3 to 4 3 to 5 4 to 6 1

Time to 25% 20 to 35 30 to 50 (60 to 60 to 120 15 to 20 20 to 35 30 to 60 5 to 10
recovery (min) 80 with RSII
dose)

Elimination half-life (min)

Normal organ 50 to 60 60 to 100 100 to 130 21 <1

2 to 2.5 23 to 30
function

Mild increase 100 to 300 Increased x2 3 to 4 21 <1

Renal Mild increase
impairment
Significant 120 to 400 Increased x2 3 to 6 21 23 to 30 <1
H e pa ti c
increase
impairment

Ma in te nan c e 0.01 0.10 0.02 0.10 0.10 0.01 N/A

dose (mg/kg)

Infusion dose 1 to 2 5 to 12 20 to 40 (not 5 to 8 10 to 20 1 to 3

(mcg/kg/min) recommended)
Elimination Renal 10 to Renal 30%; Renal 40 to Renal 10%; Hoffman 30%; Butyrylcholinesterase
Pl a s m a
route/metabolism 50%; hepatic 70% 70%; c holi nes t er ase (7 0% Hoffman 30%; ester hydrolysis (plasma
hepatic 30 to h e pa ti c 2 0 % ester hydrolysis 609+0 cholinesterase,
of succinylcholine
50% 60% ps eu do ch olin est er as e)
rate)
Active 3-desacetyl- 17-desacetyl- 3-OH- N o a c t i v e m e t a bo l i t e s No active No active N o a c t i v e m e t a bo l i t e s
metabolites v e c u r o ni um rocuronium pancuronium; metabolites metabolites
(minimal) 17-0H-
pa nc uroni um

Side effec ts Vagal blocka de Minimal Vagal black H i s t a mi n e r el e a s e H i s t a mi n e None; histamine Myalgia; bradyc ardia/
with large (tachycardia), release; r el eas e a t hi gh asystole in children or
doses catecholamine laudanosine and doses with repeated dosing;
release acrylates dual (phase I I,
production competitive) block;
a n a ph y l a xi s

Contraindications None None Short surgical Pseudocholinesterase Hemodynamically None

High K - '; MH; muscular
(other than pro c e dur es ( c6 0 deficiency unstable dystrophy; children;
specific allergy) min); not patients due to receptor up-regulation
r e c o m m en de d settings;
h is t a m in e
for continuous ps eu do ch olin est er as e
r el eas e
infusion deficiency

C om m en ts Not for Pain on Significant R e v e r s al by Organ- Trivial histamine F a s t e s t o n s e t , m os t

prolonged ICU injection; easily accumulation, ch ol in es ter as e independent release; minimal reliable NMBA for rapid
administration reversible by prone to inhibitors; mixture of elimination pl a s m a t r a c h e a l i n t u ba t i on
(myopathy); sugammadex; residual block 3 isomers (cis -cis laudanosine and
reversible by elimination half- (3-OH minimal); acrylate lev els
sugammadex; life prolonged in e dr o ph o n iu m f or
metabolite has
elimination ICU patient; 17- a n t a go n i sm m or e
50% activity of
half-life halved de s a c e ty l effective during deep
pancuronium)
m e ta bo l i te h a s block
in late
20% ac tivity
pregnancy; 3-
de s a c e t y l
metabolite has
60% of the
parent
compound
po t e n c y

NA: da ta no t available ; ED 9 5 : effec tive do se to achieve 95% de pression of baseline muscle contrac tion; NMBA: neuromuscular blocking a gents; RSII: ra pid s equence
in du c tio n an d in tu ba tio n; K +: po tassi um; MH : m ali gn an t hy per th ermi a; S T: si n gle tw it ch ; IC U: in t ensi ve c are uni t.
- T h e da t a a r e a v e r a ge s o bt a i n e d f r o m pu bl is h e d l i te r a tur e a n d do n o t a c c o u n t f o r o t h e r i nf lu e n c e s s u c h as v o l a t il e a n e st h e t i c s , m us c l e t e m pe r a t u r e , e t c .

Adapted from: Brull Si. Neuromuscular blocking agents. In: Clinical Anesthesia, 8th ed, Barash PE, Cullen BF, Stocking RK, eta! (Eds), Wolters Kluwer, Philadelphia 2017.

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