▶Child 6 months–11 years:Initially 200 micrograms/kg,
then (by intravenous injection) 100 micrograms/kg
every 6 – 9 minutes as required, alternatively (by
intravenous infusion)^8 –^10 micrograms/kg/minute, (by
intravenous infusion) adjusted in steps of
1 microgram/kg/minute every 3 minutes if required;
(by intravenous infusion) usual dose
11 – 14 micrograms/kg/minute
▶Child 12–17 years:Initially 70 – 250 micrograms/kg, then
(by intravenous injection) 100 micrograms/kg every
15 minutes as required, alternatively (by intravenous
infusion) 8 – 10 micrograms/kg/minute, (by intravenous
infusion) adjusted in steps of 1 microgram/kg/minute
every 3 minutes if required; (by intravenous infusion)
usual dose 6 – 7 micrograms/kg/minute
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal bodyweight.lCAUTIONSBurns (low plasma cholinesterase activity; dose
titration required)
lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTS
▶UncommonErythema
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose in severe impairment.
lRENAL IMPAIRMENT
Dose adjustmentsClinical effect prolonged in renal
failure—reduce dose according to response.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, give undiluted or dilute in Glucose 5 % or Sodium
Chloride 0. 9 %. Doses up to 150 micrograms/kg may be
given over 5 – 15 seconds, higher doses should be given
over 30 seconds. In asthma, cardiovascular disease or in
those sensitive to reduced arterial blood pressure, give
over 60 seconds.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Mivacron(Aspen Pharma Trading Ltd)
Mivacurium (as Mivacurium chloride) 2 mg per 1 mlMivacron
10 mg/ 5 ml solution for injection ampoules| 5 ampouleP£ 13. 95
Mivacron 20 mg/ 10 ml solution for injection ampoules|
5 ampouleP£ 22. 57
eiiiiF 813
Pancuronium bromide
lINDICATIONS AND DOSE
Neuromuscular blockade (long duration) during surgery
▶BY INTRAVENOUS INJECTION
▶Neonate:Initially 100 micrograms/kg, then
50 micrograms/kg, repeated if necessary.▶Child:Initially 100 micrograms/kg, then
20 micrograms/kg, repeated if necessary
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal bodyweight.lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTSApnoea.arrhythmia.hypersalivation.
increased cardiac output.miosis
SIDE-EFFECTS, FURTHER INFORMATIONPancuronium lacks
histamine-releasing effect, but vagolytic and
sympathomimetic effects can cause tachycardia.
lHEPATIC IMPAIRMENTPossibly slower onset, higher dose
requirement, and prolonged recovery time.
lRENAL IMPAIRMENTUse with caution; prolonged duration
of block.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, give undiluted or dilute in Glucose 5 % or Sodium
Chloride 0. 9 %.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Pancuronium bromide (Non-proprietary)
Pancuronium bromide 2 mg per 1 mlPancuronium bromide
4 mg/ 2 ml solution for injection ampoules| 10 ampouleP£ 50. 00
(Hospital only)eiiiiF 813Rocuronium bromide
lINDICATIONS AND DOSE
Neuromuscular blockade (intermediate duration) during
surgery
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 600 micrograms/kg, then (by
intravenous injection) 150 micrograms/kg, repeated if
necessary, alternatively (by intravenous infusion)
300 – 600 micrograms/kg/hour, adjusted according to
response.▶Child:Initially 600 micrograms/kg, then (by
intravenous injection) 150 micrograms/kg, repeated if
necessary, alternatively (by intravenous infusion)
300 – 600 micrograms/kg/hour, adjusted according to
response
Assisted ventilation in intensive care
▶INITIALLY BY INTRAVENOUS INJECTION
▶Child:Initially 600 micrograms/kg, initial dose is
optional, then (by intravenous infusion)
300 – 600 micrograms/kg/hour forfirst hour, then (by
intravenous infusion), adjusted according to response
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal bodyweight.lUNLICENSED USENot licensed for use in children for
assisted ventilation in intensive care.
lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTS
▶Rare or very rareAngioedema.face oedema.
hypersensitivity.malignant hyperthermia.paralysis.rash
erythematous
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce dose.
lRENAL IMPAIRMENT
Dose adjustmentsReduce maintenance dose; prolonged
paralysis.
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusionor via drip tubing, may be diluted with
Glucose 5 % or Sodium Chloride 0. 9 %.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Rocuronium bromide (Non-proprietary)
Rocuronium bromide 10 mg per 1 mlRocuronium bromide
50 mg/ 5 ml solution for injection ampoules| 10 ampouleP£ 24. 00
Rocuronium bromide 50 mg/ 5 ml solution for injection vials|
10 vialP£ 28. 00 – £ 30. 00
Rocuronium bromide 100 mg/ 10 ml solution for injection vials|
10 vialP£ 57. 00 – £ 57. 90BNFC 2018 – 2019 Neuromuscular blockade 815
Anaesthesia15