Anaes · Vecuronium
Vecuronium
Also known as Aminosteroid muscle relaxant · Intermediate-acting non-depolarising blocker · Norcuron
Vecuronium for the anaesthesia fellowship exams: mechanism, cardiovascular profile, onset and duration, elimination and the active metabolite, reversal, anaphylaxis, and comparison with atracurium.
Checked against its sources on 23 Oct 2026
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- 3-desacetyl vecuronium has 50% or more of the potency of vecuronium in animal screening, and prolonged blockade after long-term ICU vecuronium was associated with renal failure and high metabolite levels.
- Intubation conditions after vecuronium 0.08 to 0.1 mg/kg take 2.5 to 3 minutes; rocuronium is labelled for both rapid sequence and routine intubation.
- Sugammadex forms a complex with rocuronium and vecuronium and is indicated to reverse both.
- Severe, sometimes fatal anaphylaxis to neuromuscular blockers, including vecuronium, has been reported; neuromuscular blockers were the main cause of perioperative anaphylaxis in GERAP.
Mechanism and the cardiovascular signature
Competitive antagonism. Vecuronium acts by competing for cholinergic receptors at the motor end-plate, and the block is reversed by acetylcholinesterase inhibitors such as neostigmine, edrophonium and pyridostigmine.[6]
Cardiovascular stability. In good-risk surgical patients, doses up to 0.15 mg/kg did not produce clinically significant changes in systolic, diastolic or mean arterial pressure, and 0.28 mg/kg before coronary artery bypass grafting did not alter rate-pressure product or pulmonary capillary wedge pressure. Clinical doses are not characterised by signs of chemically mediated histamine release.[6]
References9ShowHide
- [1]Bowman WC Neuromuscular block. Br J Pharmacol, 2006.PMID 16402115
- [2]Segredo V, Caldwell JE, Matthay MA, et al. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med, 1992.PMID 1353252
- [3]Segredo V, Shin YS, Sharma ML, et al. Pharmacokinetics, neuromuscular effects, and biodisposition of 3-desacetylvecuronium (Org 7268) in cats. Anesthesiology, 1991.PMID 1675040
- [4]Staals LM, van Egmond J, Driessen JJ, et al. Sugammadex reverses neuromuscular block induced by 3-desacetyl-vecuronium, an active metabolite of vecuronium, in the anaesthetised rhesus monkey. Eur J Anaesthesiol, 2011.PMID 21157358
- [5]Tacquard C, Serrier J, Viville S, et al. Epidemiology of perioperative anaphylaxis in France in 2017-2018: the 11th GERAP survey. Br J Anaesth, 2024.PMID 38493055
- [6]Sun Pharmaceutical Industries, Inc. VECURONIUM BROMIDE injection, powder, lyophilized, for solution — prescribing information. DailyMed, 2026.Source
- [7]Hospira, Inc. ATRACURIUM BESYLATE injection, solution — prescribing information. DailyMed, 2023.Source
- [8]Baxter Healthcare Corporation ROCURONIUM BROMIDE injection, solution — prescribing information. DailyMed, 2026.Source
- [9]Shandong New Time Pharmaceutical Co., Ltd. SUGAMMADEX injection, solution — prescribing information. DailyMed, 2026.Source