Pavulon

Drug Description:

Pavulon (pancuronium bromide) is a non-depolarizing neuromuscular blocking agent used to induce skeletal muscle relaxation during tracheal intubation and surgery. It works by blocking the action of acetylcholine at the neuromuscular junction, causing muscle paralysis. Pavulon is typically administered as an adjunct to general anesthesia to facilitate intubation and maintain muscle relaxation throughout the surgical procedure.

Indications:

• Adjunct to general anesthesia: Facilitates tracheal intubation and provides skeletal muscle relaxation during surgery or mechanical ventilation.

Dosage:

• Adult Dosage:

  • Initial dose: 0.04 to 0.1 mg/kg body weight intravenously (IV).

  • For maintenance: Incremental doses of 0.01 mg/kg.

  • For endotracheal intubation: 0.06 to 0.1 mg/kg.

• Pediatric Dosage:

  • Similar to adults, except in neonates (contraindicated due to benzyl alcohol content).

Note: Dosing should be individualized, and monitoring of muscle response is crucial.

Side Effects:

• Common:

  • Muscle weakness.

  • Drooling.

  • Increased saliva.

  • Flushing or redness.

  • Blood pressure changes (high or low).

• Serious:

  • Respiratory insufficiency.

  • Prolonged paralysis.

  • Anaphylaxis or hypersensitivity reactions.

  • Bronchospasm.

  • Tachycardia (rapid heartbeat).

Drug Interactions:

• Enhances effects with:

  • Succinylcholine, vecuronium, enflurane, isoflurane.

• Antibiotics (aminoglycosides, neomycin, bacitracin, etc.) may potentiate neuromuscular block.

• Caution with:

  • Inhalational anesthetics (e.g., halothane, isoflurane).

  • Tricyclic antidepressants with halothane.

Warnings and Precautions:

• Respiratory support: Ensure that facilities for tracheal intubation, artificial respiration, and reversal agents are available.

• Anaphylaxis: Severe allergic reactions are possible; take emergency precautions.

• Renal or hepatic impairment: Use with caution as the drug may be metabolized differently in patients with these conditions.

• Pediatric use: Contraindicated in neonates due to benzyl alcohol toxicity (gasping syndrome).

• Long-term use in ICU: Prolonged use may lead to muscle weakness or paralysis.

Contraindications:

• Hypersensitivity to pancuronium bromide.

• Neonates and premature infants (due to benzyl alcohol content).

Pregnancy Category: C

• Use during pregnancy only if benefits outweigh risks. Not recommended during labor.

Storage:

• Room temperature: 18° to 22°C (65° to 72°F) for 6 months.

• Refrigerated: 2° to 8°C (36° to 46°F) for up to 3 years.

Clinical Pharmacology:

• Mechanism of Action: Non-depolarizing agent that blocks acetylcholine at the neuromuscular junction, preventing muscle contraction.

• Half-Life: 89–161 minutes.

• Elimination: 40% excreted in urine, 11% in bile.

Overdose:

• Symptoms: Prolonged paralysis, respiratory insufficiency.

• Management: Supportive ventilation and use of reversal agents (neostigmine, edrophonium).

Doctor Review:

Dr. Jennifer Collins, Anesthesiologist, recommends that Pavulon is effective for muscle relaxation in surgical procedures but must be used with caution. Dosage should be individualized, and continuous monitoring is crucial to avoid complications like prolonged paralysis or respiratory issues. Special care should be taken with patients who have renal or hepatic impairments, and Pavulon should not be used in neonates due to the presence of benzyl alcohol.

Disclaimer:

This review is for informational purposes only. Always consult a qualified healthcare provider before using Pavulon (pancuronium bromide). It should be administered under the supervision of a trained professional familiar with neuromuscular blocking agents.