see also:

• neuro-muscular blockers
• rapid sequence induction (RSI) for emergency intubation

• a non-depolarising competitive acetylcholine antagonist at nicotinic receptors
• the most commonly used non-depolarising neuromuscular blocking agent (NMBA) in the ED for maintenance of paralysis in intubated patients.
• as with other non-depolarising NMBAs, its actions can be reversed with neostigmine (0.06 to 0.08 mg/kg IV) after approximately 40 percent of neuromuscular function has returned

• usual maintenance bolus iv doses: 0.02 to 0.04 mg/kg to max. adult dose 10mg as needed (usually every 30min or so)
• duration of action 25-40min

• vecuronium or rocuronium can be used at induction if suxamethonium is contra-indicated or not desired.
• a priming dose of 0.01 mg/kg is administered three minutes before an increased intubating dose of 0.15 mg/kg.
• used in this way, vecuronium achieves intubation level paralysis in approximately 75 to 90 seconds

• Ensure adequate anaesthesia, sedation; neuromuscular disease incl myasthenia gravis; prior poliomyelitis; factors predisposing to residual curarisation; hepatobiliary, renal (incl failure), CV disease; electrolyte, acid/ base, circulatory disturbances; hypoproteinaemia; dehydration; acidosis; hypercapnia; cachexia; hypothermia; obesity; oedema; burns; prolonged use (monitor neuromuscular transmission); hypersensitivity to other muscle relaxants; elderly; pregnancy, lactation, infants