Skip to main content

The originating document has been archived. We cannot confirm the completeness, accuracy, or currency of the content.

Vecuronium Bromide (Monograph)

Drug class: Neuromuscular Blocking Agents

Medically reviewed by Drugs.com on Apr 10, 2025. Written by ASHP.

Warning

  • Should be administered only by adequately trained clinicians experienced in the use and complications of neuromuscular blocking agents.1

Introduction

Nondepolarizing neuromuscular blocking agent; aminosteroid.1 3 4 5 420

Uses for Vecuronium Bromide

Skeletal Muscle Relaxation

Production of skeletal muscle relaxation during surgery after general anesthesia has been induced.1 420

Facilitation of endotracheal intubation;1 15 16 30 39 40 41 46 54 63 68 71 77 80 113 117 124 129 131 142 however, a neuromuscular blocking agent with a rapid onset of action (e.g., succinylcholine, rocuronium) generally preferred in emergency situations when rapid intubation is required.110 111 112 141 145 421 424

Has been used to facilitate mechanical ventilation in the ICU; however, manufacturer states insufficient data available to support dosage recommendations for such use.1 186 187 188 189 190 191 192 193 341 421 Whenever neuromuscular blocking agents are used in the ICU, consider benefits versus risks of such therapy and assess patients frequently to determine need for continued paralysis.1 421 (See Intensive Care Setting under Cautions.)

Compared with other neuromuscular blocking agents, vecuronium has an intermediate onset and duration of action, and exhibits minimal cardiovascular effects.1 3 18 49 143 145 420 421 Not suitable for rapid sequence intubation, but may be used for procedures requiring profound muscle relaxation for short durations (e.g., laryngoscopy, bronchoscopy) or for maintenance of neuromuscular blockade during the postintubation period.18 145 421 424

Vecuronium Bromide Dosage and Administration

General

Dispensing and Administration Precautions

Reversal of Neuromuscular Blockade

Administration

Administer IV only;1 do not administer IM.144

IV Administration

Administer initial (intubating) dose by rapid IV injection;1 administer maintenance doses by intermittent IV injection or continuous IV infusion.1

Use of a controlled-infusion device is recommended during continuous IV infusion.359

Rate of spontaneous recovery following discontinuance of a maintenance infusion usually is comparable to that following administration of a single IV injection.1

Repeated administration of maintenance doses appears to have little, if any, cumulative effect on duration of neuromuscular blockade.1 16 17 40 51 62 71 72 80 93 143

Consult specialized references for specific procedures and techniques of administration.

Do not mix in the same syringe or administer through the same needle as an alkaline solution.1

Reconstitution

Reconstitute vecuronium bromide for injection with a compatible IV solution (e.g., 5% dextrose, 5% dextrose and 0.9% sodium chloride, 0.9% sodium chloride, lactated Ringer's, bacteriostatic water for injection).1

When reconstituted with bacteriostatic water for injection, use within 5 days; when reconstituted with other compatible solutions, use within 24 hours and discard unused portions.1

Dilution

For continuous IV infusion, dilute the reconstituted solution to the desired concentration (usually 0.1 or 0.2 mg/mL) in a compatible IV solution .1 2 30 80 113 Vecuronium is unstable in the presence of bases.10 11

Standardize 4 Safety

Standardized concentrations for vecuronium have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care.249 250 Because recommendations from the S4S panels may differ from the manufacturer’s prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label.249 250 For additional information on S4S (including updates that may be available), see [Web].249 250

Paralytics are recommended to be administered as straight drug. This provides consistency between operating room and the ICU, and eliminates potential compounding errors.

dosing units differ from concentration units

Babies under 500 g may require a lower concentration.

Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Vecuronium249250

Patient Population

Concentration Standards

Dosing Units

Adults

1 mg/mL

mcg/kg/min

Pediatric patients (<50 kg)

1 mg/mL

mg/kg/hr

Dosage

Available as vecuronium bromide; dosage expressed in terms of the salt.1

Adjust dosage carefully according to individual requirements and response.1 2

Pediatric Patients

Skeletal Muscle Relaxation
Initial (Intubating) Dose
IV

Infants >7 weeks but <1 year of age may receive doses comparable to those used in adults, but may experience a longer period of time (about 1.5 times) to neuromuscular recovery.27 148 (See Adults under Dosage and Administration.)

Children 1–9 years of age may require slightly higher initial doses than adults.1 2 27 28 (See Adults under Dosage and Administration.)

Children >10 years of age should receive doses recommended for adults.1 2 (See Adults under Dosage and Administration.)

Maintenance Dosage
Intermittent IV Injection

Infants 7 weeks to 1 year of age may receive doses recommended for adults; however, less frequent administration may be necessary.27 148 (See Adults under Dosage and Administration and also see Pediatric Use under Cautions.)

Children 1–9 years of age may require more frequent doses than adults.1 2 28 (See Adults under Dosage and Administration.)

Children >10 years of age should receive dosages recommended for adults.1 2 (See Adults under Dosage and Administration.)

Continuous IV Infusion

Dosage recommendations not established; administration by continuous IV infusion not adequately studied in pediatric patients.1

Adults

Skeletal Muscle Relaxation
Initial (Intubating) Dose
IV

0.08–0.1 mg/kg.1 2 Following administration of this initial dose, endotracheal intubation for nonemergency surgical procedures can be performed within 2.5–3 minutes in most patients.1 61 75 (See Onset and also Duration under Pharmacokinetics.)

Reduce initial dose by about 15% (i.e., to 0.06–0.085 mg/kg) when administered >5 minutes after administration of enflurane, isoflurane, or halothane has been initiated or after steady-state anesthesia has been achieved.1 2 (See Specific Drugs under Interactions.)

If larger initial dose is required, 0.15–0.28 mg/kg has been administered in patients undergoing halothane anesthesia with minimal adverse cardiovascular effects as long as ventilation was adequately maintained.1 2

If administering following succinylcholine, reduce dose to 0.05–0.06 mg/kg with balanced anesthesia or 0.04–0.06 mg/kg with inhalation anesthesia.1 2

Maintenance Dosage
Intermittent IV Injection

0.01–0.015 mg/kg, administered as necessary, in patients receiving balanced anesthesia.1 2

0.008–0.012 mg/kg, administered as necessary, in patients receiving inhalation anesthesia.

First maintenance dose generally required 25–45 minutes after the initial dose in patients undergoing balanced or inhalation anesthesia.1 2

May administer repeat maintenance doses at relatively regular intervals (i.e., from 12–15 minutes in patients undergoing balanced anesthesia or at slightly longer intervals in those undergoing enflurane or isoflurane anesthesia).1 2

May increase dose (i.e., to >0.01–0.015 mg/kg) if longer intervals between maintenance doses are desirable.1

Continuous IV Infusion

After initial intubating dose is administered, may initiate continuous IV infusion to maintain neuromuscular blockade during prolonged procedures.1

Individualize infusion rates based on patient response to peripheral nerve stimulation.1

Manufacturer recommends initial rate of 1 mcg/kg per minute.1 Subsequently adjust infusion rate to maintain 90% neuromuscular blockade; 0.8–1.2 mcg/kg per minute usually maintains continuous neuromuscular blockade in most patients.1 39

Initiate continuous IV infusion only after early spontaneous recovery from initial IV dose is evident (approximately 20–40 minutes after administration of initial dose1 30 33 39 76 80 113 118 ).1 Required infusion rates decrease progressively and become relatively constant within 30–50 minutes.30 39 113

May need to reduce infusion rate by about 25–60% approximately 45–60 minutes following initial IV dose if steady-state anesthesia has been induced with enflurane or isoflurane.1 Reduction in infusion rate may not be necessary if steady-state anesthesia has been induced with halothane.1

Manufacturer states use of continuous IV infusion during mechanical ventilation in the ICU has not been adequately studied to date to establish dosage recommendations.1

Special Populations

Hepatic Impairment

Data currently insufficient for specific dosage recommendations.1 Some clinicians suggest usual initial dose;141 151 others suggest a reduced initial dose.141 Adjust maintenance dosing (probably with reduced doses) carefully according to patient’s response.141 151 (See Hepatic Impairment under Cautions.)

Renal Impairment

Usual initial and maintenance doses recommended for patients with renal failure who are optimally prepared with dialysis prior to surgery; monitor carefully to determine interval between doses.141 149 (See Renal Impairment under Cautions.)

Manufacturer recommends consideration of decreased initial dose if emergency surgery is necessary in patients with severe renal failure (i.e., Clcr <10 mL/minute) who are not optimally prepared with dialysis;1 2 however, most clinicians believe that usual initial dose may be given.141 Adjust maintenance doses carefully according to patient’s response.141

Geriatric Patients

Dosage necessary to maintain steady-state neuromuscular blockade30 32 33 may be decreased.

Burn Patients

Substantially increased doses may be required due to development of resistance.175 (See Burn Patients under Cautions.)

Patients with Neuromuscular Disease

Administer small test dose (e.g., 0.005–0.02 mg/kg)141 144 and monitor response.1 (See Neuromuscular Diseases under Cautions.)

Other Populations

Patients in whom substantial histamine release would be particularly hazardous (e.g., patients with clinically important cardiovascular disease) or patients with any history suggesting a greater risk of histamine release (e.g., a history of severe anaphylactoid reactions or asthma): Administer slowly over 1–2 minutes or longer; discontinue administration if any signs of histamine release occur.141 144 (See Hypersensitivity Reactions under Cautions.)

Detailed Vecuronium dosage information

Cautions for Vecuronium Bromide

Contraindications

Warnings/Precautions

Warnings

Administration Precautions

Because of the potential for severely compromised respiratory function and other complications, take special precautions during administration.1 110 111 127 128 (See Boxed Warning and also see General under Dosage and Administration.)

Neuromuscular Diseases

Possible exaggerated neuromuscular blockade in patients with neuromuscular diseases (e.g., myasthenia gravis, Eaton-Lambert syndrome).1

Administer small test dose; monitor response carefully with a peripheral nerve stimulator.1 141 144

Sensitivity Reactions

Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylaxis, reported rarely.1 Potential for cross-sensitivity with other neuromuscular blocking agents (both depolarizing and nondepolarizing).1

Take appropriate precautions; emergency treatment for anaphylaxis should be immediately available.1

General Precautions

Burn Patients

Resistance to therapy can develop in burn patients,169 170 172 173 174 175 particularly those with burns over 25–30% or more of body surface area.175

Resistance becomes apparent ≥1 week after the burn,169 170 171 172 173 174 175 peaks ≥2 weeks after the burn,170 171 172 174 persists for several months or longer,170 172 and decreases gradually with healing.169 170 172 174

Consider possible need for substantially increased doses.175

Cardiovascular Effects

Exhibits minimal cardiovascular effects;1 3 5 6 19 143 therefore, will not counteract the bradycardia induced by many anesthesia agents1 21 59 (e.g., high-dose fentanyl)122 143 or by vagal stimulation.141

Possible delayed onset of action and delayed maximum effect in patients with impaired circulation or in those with cardiovascular disease or edema (vecuronium volume of distribution may be increased).1 2 141 Larger-than-usual initial doses are not recommended; caution advised when administering a subsequent dose before the maximum effect of the initial dose is attained.141

Intensive Care Setting

Possible prolonged paralysis and/or muscle weakness and atrophy with long-term administration of neuromuscular blocking agents in the ICU.1

Continuous monitoring of neuromuscular transmission recommended during neuromuscular blocking agent therapy in intensive care setting.1 Do not administer additional doses before there is a definite response to nerve stimulation tests.1 If no response is elicited, discontinue administration until response returns.1

Electrolyte Disturbances

Possible prolonged paralysis in patients with electrolyte disturbances (e.g., increased plasma magnesium concentrations) or acid-base imbalances.186 187 189 190

Carefully monitor the degree of neuromuscular blockade with a peripheral nerve stimulator in patients with severe electrolyte disturbances (i.e., hypermagnesemia, hypokalemia, hypocalcemia)141 or diseases that result in electrolyte disturbances (e.g., adrenocortical insufficiency).141

Malignant Hyperthermia

Malignant hyperthermia is rarely associated with use of neuromuscular blocking agents and/or potent inhalation anesthetics.1 b Insufficient data to determine whether vecuronium is capable of initiating the development of this condition.1

Be vigilant for possible development of malignant hyperthermia and prepared for its management in any patient undergoing general anesthesia.168

Carcinomatosis

Carefully monitor the degree of neuromuscular blockade with a peripheral nerve stimulator.1

Obesity

Use with caution in severely obese patients; maintenance of adequate airway and ventilation support prior to, during, and following administration of neuromuscular blocking agents may require particular care.1

Debilitated Patients

Carefully monitor the degree of neuromuscular blockade with a peripheral nerve stimulator in patients with severe debilitation.1

Specific Populations

Pregnancy

Category C.1

Lactation

Not known whether vecuronium is distributed into milk.1 141 Caution advised if used in nursing women.1 141

Pediatric Use

Safety and efficacy not established in children <7 weeks of age.1 144

Has been used safely and effectively in children >7 weeks of age who were undergoing surgery.27 28 Children 7 weeks–1 year of age may be more sensitive than adults to the neuromuscular blocking effects and generally require 50% longer to recover from neuromuscular blockade.1 2 27 148

Vecuronium bromide that has been reconstituted with bacteriostatic water for injection containing benzyl alcohol should not be used in neonates.1 163 164 165 166 167

Geriatric Use

Possible increased time to onset of neuromuscular blockade31 and decreased rate of recovery compared with younger adults.30 32 33

Hepatic Impairment

Prolonged duration of and rate of recovery from neuromuscular blockade.1 38 79 90

Use with caution; careful monitoring with a peripheral nerve stimulator recommended.1

Renal Impairment

Onset and duration of and rate of recovery from neuromuscular blockade not substantially altered by renal dysfunction;1 74 84 149 however, possible prolonged duration of blockade in patients with severe renal impairment who have not undergone dialysis prior to surgery.1 2 Careful monitoring with a peripheral nerve stimulator recommended to avoid inadvertent overdosage; consider reduced initial dose.1

Common Adverse Effects

Skeletal muscle weakness.1

Drug Interactions

Specific Drugs

Drug

Interaction

Comments

Acylaminopenicillins (e.g., piperacillin)

Prolonged neuromuscular blockade158 159

Use with caution158 159

Anesthetics, general (enflurane, halothane, isoflurane)

Increased potency and prolonged duration of neuromuscular blockade1 2 3 13 14 18 23 73 89 129 143

Reduced vecuronium dosage may be required1 2 14 23 89

Anti-infective agents (e.g., aminoglycosides, bacitracin, clindamycin, lincomycin, polymyxins, tetracyclines)

Possible prolonged duration of neuromuscular blockade1 2 3 13 18 156

Magnesium salts

Increased neuromuscular blockade;1 141 154 155 reversal may be impeded1 141 155

Use with caution; reduce vecuronium dosage as necessary1 141 154 155

Neuromuscular blocking agents

Possible increased neuromuscular blockade1

Concomitant administration not recommended1

Quinidine

Possible recurrence of paralysis1

Succinylcholine

Possible increased potency and prolonged duration of neuromuscular blockade1 2 3 21 33 62 124 131 132

Administer vecuronium in reduced dosage after effects of succinylcholine begin to dissipate1
Vecuronium drug interactions (more detail)

Vecuronium Bromide Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from the GI tract.b

Onset

Time to maximum neuromuscular blockade decreases as the dose increases.1 2 17 18 26 46 69 70 87

Following IV administration of 0.08–0.1 mg/kg, neuromuscular blockade begins within 1 minute and is maximal at 3–5 minutes.1 2

Duration

Duration of neuromuscular blockade increases as the dose increases.1 2 17 47 70 80 87

Duration of clinically sufficient neuromuscular blockade induced by initial dose of 0.08–0.1 mg/kg under balanced or halothane anesthesia is about 25–30 or 30–40 minutes, respectively.2

Spontaneous recovery to about 25% of baseline generally occurs within 25–40 minutes under balanced anesthesia and is usually 95% complete 45–65 minutes after administration.1

The time necessary for 25–75% recovery from neuromuscular blockade following doses of 0.08–0.1 mg/kg under balanced or halothane anesthesia is about 15–25 minutes;1 144 recovery time following initial doses appears to be dose dependent.17 141

Special Populations

Hepatic dysfunction (i.e., cirrhosis, cholestasis) may prolong duration of and rate of recovery from neuromuscular blockade.1 38 79 90

In patients with severe renal impairment who have not undergone dialysis prior to surgery, duration of neuromuscular blockade may be prolonged.1 2

In geriatric patients, increased time of onset31 and decreased rate of recovery from neuromuscular blockade.30 32 33

In patients undergoing cardiopulmonary bypass surgery under induced hypothermia, duration of neuromuscular blockade may be prolonged.152

Distribution

Extent

Appears to rapidly distribute into extracellular space.2 100 Undergoes rapid and extensive hepatic extraction.116 Crosses the placenta minimally;94 95 96 97 not known whether distributed into milk.144

Plasma Protein Binding

Approximately 60–90%.1 2 57 99

Special Populations

In children <1 year of age, volume of distribution is increased.148 In geriatric patients, volume of distribution may be decreased.100 In patients with renal failure, volume of distribution may be slightly increased.74 84 104

Elimination

Metabolism

Metabolic fate not fully characterized in humans.1 2 3 106 116 143 In vitro, vecuronium undergoes spontaneous deacetylation to form hydroxy derivatives.9

Elimination Route

Excreted principally in feces via biliary elimination;1 38 79 90 143 also excreted in urine.1 2 106 116

Half-life

Biphasic;1 3 18 26 38 84 94 95 98 104 terminal elimination half-life averages 65–75 minutes.1

Special Populations

In patients with cirrhosis, half-life averages 84 minutes.38

In patients with renal failure, half-life not substantially altered;84 104 potential for high plasma concentrations of 3-desacetyl vecuronium (neuromuscular blocking activity is ≥50% of that of vecuronium).186 187 189 190 84 104

During late pregnancy, half-life decreases to about 35–40 minutes.1 2 94 95

Stability

Storage

Parenteral

Powder for Injection

20–25°C; protect from light.1 2

Following reconstitution with bacteriostatic water for injection, store at room temperature or under refrigeration; use within 5 days.1

Following reconstitution with sterile water for injection or other compatible solution , store under refrigeration and use within 24 hours.1

Actions

Advice to Patients

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Vecuronium Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection, for IV use only

10 mg*

Vecuronium Bromide for Injection

20 mg*

Vecuronium Bromide for Injection

AHFS DI Essentials™. © Copyright 2025, Selected Revisions September 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

References

1. Pfizer. Vecuronium bromide for injection prescribing information. New York, NY; 2011 Feb.

2. Organon Inc. Product information form for American Hospital Formulary Service on Norcuron. West Orange, NJ; 1984 May.

3. Durant NN. Norcuron, a new nondepolarizing neuromuscular blocking agent. Semin Anesth. 1982; 1:47-56.

4. AMA Division of Drugs. AMA drug evaluations. 5th ed. Chicago: American Medical Association; 1983:419-44.

5. Miller RD. Is atracurium an ideal neuromuscular blocking drug? Anesth Analg (Cleveland). 1982; 61:721-2. Editorial. (IDIS 157359)

6. Savarese JJ. The new neuromuscular blocking drugs are here. Anesthesiology. 1981; 55:1-3. https://pubmed.ncbi.nlm.nih.gov/6113792

7. Bowman WC. New neuromuscular blocking drugs in anaesthetic practice. Pharm Int. 1983; 4:131-4.

8. Booij LHDJ, Vree TB, Crul JF. Org-NC45: a new steroidal non-depolarizing muscle relaxant. Pharm Weekbl Sci Ed. 1982; 1-4. (IDIS 145892)

9. Savage DS, Sleigh T, Carlyle I. The emergence of Org NC 45, 1-[(2β,3α,5α,16β,17β)-3, 17 bis(acetyloxy)-2-(1-piperidinyl) -androstan-16-yl]-1-methylpiperidinium bromide, from the pancuronium series. Br J Anaesth. 1980; 52(Suppl 1):3-9S.

10. Torda TA. Drug interactions with vecuronium and other competitive neuromuscular blockers. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:72-8.

11. Baraka A, Noueihed R, Sinno H et al. Succinylcholine-vecuronium (Org NC 45) sequence for cesarean section. Anesth Analg. 1983; 62:909-13. https://pubmed.ncbi.nlm.nih.gov/6137170

12. Robertson EN, Booij LHDJ, Fragen RJ et al. Clinical comparison of atracurium and vecuronium (Org NC 45). Br J Anaesth. 1983; 55:125-9. https://pubmed.ncbi.nlm.nih.gov/6131682

13. Richardson FJ, Agoston S. Muscle relaxants. In: Dukes MNG, ed. Side effects of drugs. Annual 6. New York: Elsevier/North Holland Inc.; 1982:128-34.

14. Rupp SM, Miller RD, Gencarelli PJ. Vecuronium-induced neuromuscular blockade during enflurane, insoflurane, and halothane anesthesia in humans. Anesthesiology. 1984; 60:102-5. https://pubmed.ncbi.nlm.nih.gov/6141748

15. Gramstad L, Lilleaasen P. Dose-response relation for atracurium, Org NC 45 and pancuronium. Br J Anaesth. 1982; 54:647-51. https://pubmed.ncbi.nlm.nih.gov/6123339

16. Buzello W, Nöldge G. Repetitive administration of pancuronium and vecuronium (Org NC 45, Norcuron) in patients undergoing long lasting operations. Br J Anaesth. 1982; 54:1151-7. https://pubmed.ncbi.nlm.nih.gov/6128011

17. Fahey MR, Morris RB, Miller RD et al. Clinical pharmacology of Org NC 45 (Norcuron): a new nondepolarizing muscle relaxant. Anesthesiology. 1981; 55:6-11. https://pubmed.ncbi.nlm.nih.gov/6113794

18. Hilgenberg JC. Comparison of the pharmacology of vecuronium and atracurium with that of other currently available muscle relaxants. Anesth Analg. 1983; 62:524-31. https://pubmed.ncbi.nlm.nih.gov/6132564

19. Richardson FJ, Agoston SA. Muscle relaxants. In: Dukes MNG, ed. Side effects of drugs. Annual 7. New York: Elsevier/North Holland Inc; 1983:144-6.

20. Gramstad L, Lilleaasen P, Minsaas B. Comparative study of atracurium, vecuronium (Org NC 45) and pancuronium. Br J Anaesth. 1983; 55(Suppl 1):95-6S. https://pubmed.ncbi.nlm.nih.gov/6687551

21. Booij LHDJ, Robertson EN. Clinical comparison between vecuronium bromide and atracurium di-besylate. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:38-45.

22. Booij LHDJ, Crul JF. A comparison of vecuronium with the hypothetical ideal neuromuscular blocking drug. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:3-8.

23. Foldes FF, Bencini A, Newton D. Influence of halothane and enflurane on the neuromuscular effects of Org NC 45 in man. Br J Anaesth. 1980; 52(Suppl 1):64-5S.

24. Hughes R, Payne JP. Clinical assessment of atracurium using the single twitch and tetanic responses of the adductor pollicis muscles. Br J Anaesth. 1983; 55(Suppl 1):47-52S.

25. Robertson EN, Fragen RJ, Booij LHDJ et al. Some effects of diisopropyl phenol (ICI 35 868) on the pharmacodynamics of atracurium and vecuronium in anaesthetized man. Br J Anaesth. 1983; 55:723-8. https://pubmed.ncbi.nlm.nih.gov/6136286

26. Bevan DR. Neuromuscular blocking drugs. Can Anaesth Soc J. 1983; 30(3: Part 2):S56-61.

27. Fisher DM, Miller RD. Neuromuscular effects of vecuronium (Org NC 45) in infants and children during N2O, halothane anesthesia. Anesthesiology. 1983; 58:519-23. https://pubmed.ncbi.nlm.nih.gov/6134483

28. Goudsouzian NG, Martyn JJA, Liu LMP et al. Safety and efficacy of vecuronium in adolescents and children. Anesth Analg. 1983; 62:1083-8. https://pubmed.ncbi.nlm.nih.gov/6139963

29. Savage DS. The discovery of vecuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:1-6.

30. d’Hollander A, Massaux F, Nevelsteen M et al. Age-dependent dose-response relationship of Org NC 45 in anaesthetized patients. Br J Anaesth. 1982; 54:653-7. https://pubmed.ncbi.nlm.nih.gov/6123340

31. d’Hollander AA, Nevelsteen M, Barvais L et al. Effect of age on the establishment of muscle paralysis induced in anaesthetized adult subjects by Org NC 45. Acta Anaesthesiol Scand. 1983; 27:108-10. https://pubmed.ncbi.nlm.nih.gov/6132514

32. d’Hollander A, Barvais L, Massaut J et al. Vecuronium in geriatric patients. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:171-4.

33. d’Hollander A, Bomblet JP, Esselen M. Administration of vecuronium bromide by intravenous infusion during long-lasting operations. Effects of age, and interaction with suxamethonium chloride. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:85-91.

34. Crul JF. General discussion. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:196-8.

35. Brandom BW, Rudd GD, Cook DR. Clinical pharmacology of atracurium in paediatric patients. Br J Anaesth. 1983; 55(Suppl 1):117-21S.

36. Funk DI, Crul JF, vd Pol FM. Effects of changes in acid-base balance on neuromuscular blockade produced by Org-NC 45. Acta Anaesthesiol Scand. 1980; 24:119-24. https://pubmed.ncbi.nlm.nih.gov/6104411

37. Gencarelli PJ, Swen J, Koot HWJ et al. The effects of hypercarbia and hypocarbia on pancuronium and vecuronium neuromuscular blockades in anesthetized humans. Anesthesiology. 1983; 59:376-80. https://pubmed.ncbi.nlm.nih.gov/6139044

38. Lebrault C, Berger JL, d’Hollander AA et al. Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis. Anesthesiology. 1985; 62:601-5. https://pubmed.ncbi.nlm.nih.gov/2859815

39. Newton DEF. Vecuronium—continuous infusion in general clinical practice. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:109-14.

40. Clarke RSJ. Intubating conditions and neuromuscular effects following administration of vecuronium bromide. Comparison with suxamethonium chloride and pancuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:60-8.

41. Thomas B, Rolly G, Huylenbroek G et al. Clinical use of vecuronium bromide in balanced anesthesia. Comparison with pancuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron(Org NC 45, vecuronium bromide). Amsterdam: Excerpta Media; 1983:76-84.

42. Fragen RJ, Shanks CA. Neuromuscular recovery after laparoscopy. Anesth Analg. 1984; 63:51-4. https://pubmed.ncbi.nlm.nih.gov/6140885

43. van Poorten JF, Dhasmana KM, Kuypers RSM et al. Verapamil and reversal of vecuronium neuromuscular blockade. Anesth Analg. 1984; 63:155-7. https://pubmed.ncbi.nlm.nih.gov/6140886

44. Gencarelli PJ, Miller RD. Antagonism of Org NC 45 (vecuronium) and pancuronium neuromuscular blockade by neostigmine. Br J Anaesth. 1982; 54:53-6. https://pubmed.ncbi.nlm.nih.gov/6119998

45. Baird WLM, Bowman WC, Kerr WJ. Some actions of Org NC 45 and of edrophonium in the anaesthetized cat and in man. Br J Anaesth. 1982; 54:375-85. https://pubmed.ncbi.nlm.nih.gov/6121569

46. Krieg N, Mazur L, Booij LHDJ et al. Intubation conditions and reversibility of a new non-depolarizing neuromuscular blocking agent, Org NC 45. Acta Anaesthesiol Scand. 1980; 24:423-5. https://pubmed.ncbi.nlm.nih.gov/6110303

47. Mirakhur RK, Ferres CJ, Clarke RSJ et al. Clinical evaluation of Org NC 45. Br J Anaesth. 1983; 55:119-24. https://pubmed.ncbi.nlm.nih.gov/6131681

48. Crul JF, Booij LHDJ. First clinical experiences with Org NC 45. Br J Anaesth. 1980; 52(Suppl 1):49-52S. https://pubmed.ncbi.nlm.nih.gov/6769450

49. Marshall IG, Agoston S, Booij LHDJ et al. Pharmacology of Org NC 45 compared with other nondepolarizing neuromuscular blocking drugs. Br J Anaesth. 1980; 52(Suppl 1):11-9S. https://pubmed.ncbi.nlm.nih.gov/6990947

50. Basta SA, Savarese JJ. Comparative histamine-releasing properties of vecuronium, atracurium, tubocurarine and metocurine. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:183-4.

51. Foldes FF, Nagashima H, Boros M et al. Muscular relaxation with atracurium, vecuronium and Duador under balanced anaesthesia. Br J Anaesth. 1983; 55(Suppl 1):97-103S. https://pubmed.ncbi.nlm.nih.gov/6600929

52. Booij LHDJ, Krieg N, Crul JF. Intradermal histamine releasing effect caused by Org-NC 45: a comparison with pancuronium, metocurine and d-tubocurarine. Acta Anaesthesiol Scand. 1980; 24:393-4. https://pubmed.ncbi.nlm.nih.gov/6162354

53. Vilardi V, Sanfilippo M, Pelaia P et al. The effect of vecuronium on intraocular pressure during general anesthesia. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:163-6.

54. Sia RL, Rashkovsky OM. Org NC 45 and intraocular pressure during anesthesia. Acta Anaesthesiol Scand. 1981; 25:219-21. https://pubmed.ncbi.nlm.nih.gov/6119868

55. Bowman WC. Preclinical pharmacology of vecuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:7-19.

56. Bowman WC. Non-relaxant properties of neuromuscular blocking drugs. Br J Anaesth. 1982; 54:147-60. https://pubmed.ncbi.nlm.nih.gov/6174134

57. Foldes FF, Deery A. Protein binding of atracurium and other short-acting neuromuscular blocking agents and their interaction with human cholinesterases. Br J Anaesth. 1983; 55(Suppl 1):31-4S.

58. Lienhart A, Desnault H, Guggiari M et al. Vecuronium bromide: dose-response curve and haemodynamic effects in anaesthetized man. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:46-53.

59. Crul JF. Conclusions. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:96-7.

60. Lienhart A, Guggiari M, Maneglia R et al. Cardiovascular effects of vecuronium in man. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:150-5.

61. Nagashima H, Kaplan R, Radnay P et al. Relaxation with Org-NC45 during neurolept anesthesia. Anesthesiology. 1981; 55:A200.

62. Krieg N, Crul JF, Booij LHDJ. Relative potency of Org NC 45, pancuronium, alcuronium and tubocurarine in anaesthetized man. Br J Anaesth. 1980; 52:783-8. https://pubmed.ncbi.nlm.nih.gov/6107097

63. Barnes PK, Smith GB, White WD et al. Comparison of the effects of Org NC 45 and pancuronium bromide on heart rate and arterial pressure in anaesthetized man. Br J Anaesth. 1982; 54:435-9. https://pubmed.ncbi.nlm.nih.gov/6121570

64. Gencarelli PJ, Roizen MF, Miller RD et al. ORG NC45 (Norcuron) and pheochromocytoma: a report of three cases. Anesthesiology. 1981; 55:690-3. https://pubmed.ncbi.nlm.nih.gov/6118079

65. Morris RB, Cahalan MK, Miller RD et al. The cardiovascular effects of vecuronium (ORG NC45) and pancuronium in patients undergoing coronary artery bypass grafting. Anesthesiology. 1983; 58:438-40. https://pubmed.ncbi.nlm.nih.gov/6132568

66. Durant NN, Marshall IG, Savage DS et al. The neuromuscular and autonomic blocking activities of pancuronium, Org NC 45, and other pancuronium analogues, in the cat. J Pharm Pharmacol. 1979; 31:831-6. https://pubmed.ncbi.nlm.nih.gov/43368

67. Marshall IG, Gibb AJ, Durant NN. Neuromuscular and vagal blocking actions of pancuronium bromide, its metabolites, and vecuronium bromide (Org NC 45) and its potential metabolites in the anaesthetized cat. Br J Anaesth. 1983; 55:703-14. https://pubmed.ncbi.nlm.nih.gov/6136285

68. Kerr WJ, Baird WLM. Clinical studies on Org NC 45: comparison with pancuronium. Br J Anaesth. 1982; 54:1159-65. https://pubmed.ncbi.nlm.nih.gov/6128012

69. Crul JF. Initial clinical experiences with vecuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:20-4.

70. Crul JF. Depolarising and nondepolarising muscle relaxants for endotracheal intubation. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:54-9.

71. Nöldge G, Bischoff G, Buzello W. Clinical characteristics of the new muscle relaxant vecuronium bromide. Comparison with pancuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron(Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:69-75.

72. Ali HH, Savarese JJ, Basta SJ et al. Evaluation of cumulative properties of three new nondepolarizing neuromuscular blocking drugs BW A444U, atracurium and vecuronium. Br J Anaesth. 1983; 55(Suppl 1):107-11S.

73. Agoston S. Clinical pharmacology of vecuronium: a preliminary report on a multicentre study in 800 patients. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:99-108.

74. Miller RD, Rupp SM, Fahey MR et al. Pharmacokinetics of vecuronium in patients with kidney disease. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:124-6.

75. Nagashima H, Kaplan R, Yun H et al. Clinical pharmacology of vecuronium: a comparison with pancuronium. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:127-31.

76. Gramstad L, Lilleaasen P. Clinical comparison of vecuronium, atracurium and pancuronium: a short communication. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:140-4.

77. Clarke RSJ, Mirakhur RK. Intubating conditions after vecuronium: a study with three doses and a comparison with suxamethonium and pancuronium. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:145-9.

78. Goudsouzian NG. Vecuronium in pediatric anesthesia. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:167-70.

79. Duvaldestin P, Lebrault C, Terestchenko MC et al. Vecuronium in patients with liver disease. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:180-2.

80. Agoston S, Salt P, Newton D et al. The neuromuscular blocking agent of Org NC 45, a new pancuronium derivative, in anaesthetized patients. A pilot study. Br J Anaesth. 1980; 52(Suppl 1):53-9S.

81. Fisher DM, Fahey MR, Cronnelly R et al. Potency determination for vecuronium (Org NC45): comparison of cumulative and single-dose techniques. Anesthesiology. 1982; 57:309-10. https://pubmed.ncbi.nlm.nih.gov/6127044

82. Gramstad L, Lilleaasen P, Minsaas B. Onset time and duration of action for atracurium, Org NC45 and pancuronium. Br J Anaesth. 1982; 54:827-30. https://pubmed.ncbi.nlm.nih.gov/6125161

83. Baird WLM, Herd D. A new neuromuscular blocking drug, Org NC 45. Br J Anaesth. 1980; 52(Suppl 1):61-2S. https://pubmed.ncbi.nlm.nih.gov/7378231

84. Fahey MR, Morris RB, Miller RD et al. Pharmacokinetics of Org NC45 (Norcuron) in patients with and without renal failure. Br J Anaesth. 1981; 53:1049-53. https://pubmed.ncbi.nlm.nih.gov/6117300

85. Schaer H, Hossli G. Preliminary clinical observations with Org NC 45. Br J Anaesth. 1980; 52(Suppl 1):65S. https://pubmed.ncbi.nlm.nih.gov/6107111

86. Williams A, Gyasi H, Melloni C et al. Clinical experience with Org NC45 (Norcuron) as the sole muscle relaxant. Can Anaesth Soc J. 1982; 29:567-72. https://pubmed.ncbi.nlm.nih.gov/6128068

87. Engbaek J, Ording H, Viby-Mogensen J. Neuromuscular blocking effects of vecuronium and pancuronium during halothane anaesthesia. Br J Anaesth. 1983; 55:497-500. https://pubmed.ncbi.nlm.nih.gov/6134535

88. Foldes FF, Yun H, Radnay PA et al. Antagonism of the NM effect of Org-NC45 by edrophonium. Anesthesiology. 1981; 55:A201.

89. Duncalf D, Nagashima H, Hollinger I et al. Relaxation with Org-NC45 during enflurane anesthesia. Anesthesiology. 1981; 55:A203.

90. Duvaldestin P, Berger JL, Videcoq M et al. Pharmacokinetics and pharmacodynamics of Org NC 45 in patients with cirrhosis. Anesthesiology. 1982; 57:A238.

91. Katz RL. General discussion. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:156-60.

92. Bencini A, Agoston S, Ket J. Use of the human “isolated arm” preparation to indicate qualitative aspects of a new neuromuscular blocking agent, Org NC 45. Br J Anaesth. 1980; 52(Suppl 1):43-7S.

93. Buzello W, Bischoff G, Kuhls E et al. The new non-depolarizing muscle relaxant Org NC 45 in clinical anaesthesia: preliminary results. Br J Anaesth. 1980; 52(Suppl 1):62-4S.

94. Dailey PA, Fisher DM, Shnider SM et al. Pharmacokinetics, placental transfer, and neonatal effects of vecuronium and pancuronium administered during cesarean section. Anesthesiology. 1984; 60:569-74. https://pubmed.ncbi.nlm.nih.gov/6145374

95. Dailey PA, Fisher DM, Shnider SM et al. Pharmacokinetics, placental transfer and neonatal effects of vecuronium and pancuronium administered during cesarean delivery. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:175-9.

96. Duvaldestin P, Demetriou M, Depoix JP. Use of vecuronium bromide and pancuronium bromide during anaesthesia for caesarean section. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:92-5.

97. Demetriou M, Depoix JP, Diakite B et al. Placental transfer of Org NC 45 in women undergoing caesarean section. Br J Anaesth. 1982; 54:643-5. https://pubmed.ncbi.nlm.nih.gov/6123338

98. Van der Veen F, Bencini A. Pharmacokinetics and pharmacodynamics of Org NC 45 in man. Br J Anaesth. 1980; 52(Suppl 1):37-41S.

99. Foldes FF, Deery A, Benad G et al. The binding of neuromuscular blocking agents to plasma proteins. Anesthesiology. 1982; 57:A274.

100. Rupp SM, Fisher DM, Miller RD et al. Pharmacokinetics and pharmacodynamics of vecuronium in the elderly. Anesthesiology. 1983; 59:A270.

101. Cronnelly R, Fisher DM, Miller RD et al. Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC45) and pancuronium in anesthetized humans. Anesthesiology. 1983; 58:405-8. https://pubmed.ncbi.nlm.nih.gov/6132566

102. Duvaldestin P, Henzel D. Binding of tubocurarine, fazadinium, pancuronium and Org NC 45 to serum proteins in normal man and in patients with cirrhosis. Br J Anaesth. 1982; 54:513-6. https://pubmed.ncbi.nlm.nih.gov/6122460

103. Bencini A. Clinical pharmacokinetics of vecuronium bromide. In: Agoston S, ed. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:25-37.

104. Meistelman C, Lienhart A, Leveque C et al. Pharmacology of vecuronium in patients with end stage renal failure. Anesthesiology. 1983; 59:A293.

105. Durant NN, Houwertjes MC, Agoston S. Hepatic elimination of Org-NC45 and pancuronium. Anesthesiology. 1979; 51(Suppl 3S):S267. https://pubmed.ncbi.nlm.nih.gov/453611

106. Sohn YJ, Bencini A, Scaf AHJ et al. Pharmacokinetics of vecuronium in man. Anesthesiology. 1982; 57:A256.

107. Upton RA, Nguyen T, Miller RD et al. Renal and biliary elimination of vecuronium (Org NC 45) and pancuronium in rats. Anesth Analg. 1982; 61:313-6. https://pubmed.ncbi.nlm.nih.gov/6121522

108. Durant NN, Houwertjes MC, Crul JF. Comparison of the neuromuscular blocking properties of Org NC 45 and pancuronium in the rat, cat and rhesus monkey. Br J Anaesth. 1980; 52:723-30. https://pubmed.ncbi.nlm.nih.gov/6107096

109. Miller RD. Pharmacokinetics of competitive muscle relaxants. Br J Anaesth. 1982; 54:161-7. https://pubmed.ncbi.nlm.nih.gov/7037026

110. Taylor P. Neuromuscular blocking agents. In: Gilman AG, Goodman L, Gilman A, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 6th ed. New York: Macmillan Publishing Company; 1980:220-34.

111. Foldes FF. Skeletal muscle relaxants. In: Pharmacology for physicians 4. 1970 May.

112. American Pharmaceutical Association. Evaluations of drug interactions. 2nd ed. Washington, DC: American Pharmaceutical Association; 1976:435-41.

113. d’Hollander AA, Czerucki R, DeVille A et al. Stable muscle relaxation during abdominal surgery using combined intravenous bolus and demand infusion: clinical appraisal with Org NC45. Can Anaesth Soc J. 1982; 29:136-41. https://pubmed.ncbi.nlm.nih.gov/6121614

114. Ferres CJ, Mirakhur RK, Craig HJL et al. Pretreatment with vecuronium as a prophylactic against post-suxamethonium muscle pain. Br J Anaesth. 1983; 55:735-41. https://pubmed.ncbi.nlm.nih.gov/6136287

115. Gyasi H, Williams A, Melloni C et al. ORG NC45 for short intra-abdominal operations: a comparison with succinylcholine. Can Anaesth Soc J. 1983; 30:132-5. https://pubmed.ncbi.nlm.nih.gov/6131736

116. Bencini A, Scaf AHJ, Sohn YJ et al. Clinical pharmacokinetics of vecuronium. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:115-23.

117. Fragen RJ, Shanks CA. Vecuronium in outpatient surgery. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:185-8.

118. Gimbrère JSF, Robertson EN. Vecuronium in intensive care. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:189-91.

119. Read DH, Boulay MD, Norman J. Onset of respiratory muscle paralysis compared with that of the hand in response to Org NC45 and pancuronium. Br J Anaesth. 1983; 55:239-40P.

120. Engbaek J, Ording H, Sorensen B et al. Cardiac effects of vecuronium and pancuronium during halothane anaesthesia. Br J Anaesth. 1983; 55:501-5. https://pubmed.ncbi.nlm.nih.gov/6134536

121. Gregoretti SM, Sohn YJ, Sia RL. Heart rate and blood pressure changes after Org NC45 (vecuronium) and pancuronium during halothane and enflurane anesthesia. Anesthesiology. 1982; 56:392-5. https://pubmed.ncbi.nlm.nih.gov/6122389

122. Salmenpera M, Peltola K, Takkunen O et al. Cardiovascular effects of pancuronium and vecuronium during high-dose fentanyl anesthesia. Anesth Analg. 1983; 62:1059-64. https://pubmed.ncbi.nlm.nih.gov/6139962

123. Viby-Mogensen J, Jorgensen BC, Engbaek J et al. On Org NC 45 and halothane anaesthesia. Br J Anaesth. 1980; 52(Suppl 1):67-9S.

124. Krieg N, Hendrickx HHL, Crul JF. Influence of suxamethonium on the potency of Org NC 45 in anaesthetized patients. Br J Anaesth. 1981; 53:259-62. https://pubmed.ncbi.nlm.nih.gov/6110433

125. Rowlands DE. Atracurium in clinical anesthesia. Br J Anaesth. 1983; 55(Suppl 1):125-8S. https://pubmed.ncbi.nlm.nih.gov/6131682

126. Miller RD. General discussion. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:192-5.

127. Waud DR, Waud BE. Agents acting on the neuromuscular junction and centrally acting muscle relaxants. In: DiPalma JR, ed. Drill’s pharmacology in medicine. 4th ed. New York: McGraw-Hill Book Company; 1971:735-63.

128. Meyers FH, Jawetz E, Goldfien A. Review of medical pharmacology. 7th ed. Los Altos, CA; Lange Medical Publications; 1980:210-16.

129. Foldes FF, Nagashima H, Ohta Y et al. Modification of the neuromuscular blocking effect of vecuronium by various anesthetic agents. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:132-9.

130. Fisher DM, Miller RD. Interaction of succinylcholine and vecuronium during N2O-halothane anesthesia. Anesthesiology. 1983; 59:A278.

131. d’Hollander AA, Agoston S, DeVille A et al. Clinical and pharmacological actions of a bolus injection of suxamethonium: two phenomena of distinct duration. Br J Anaesth. 1983; 55:131-4. https://pubmed.ncbi.nlm.nih.gov/6131683

132. Richardson FJ, Agoston SA. Muscle relaxants. In: Dukes MNG, ed. Side effects of drugs. Annual 8. New York: Elsevier/North Holland Inc; 1984:132-41.

133. Duncalf D, Chaudhry I, Aoki T et al. Potentiation of pancuronium, vecuronium and atracurium by d-tubocurarine or metocurine. Anesthesiology. 1983; 59:A292.

134. Ferres CJ, Mirakhur RK, Clarke RSJ et al. Neuromuscular blocking effects of a combination of vecuronium and pancuronium. Br J Clin Pharmacol. 1983; 16:218P.

135. Gibson FM, Ferres CJ, Clarke RSJ et al. Potentiation of neuromuscular block with a combination of vecuronium and tubocurarine. Br J Clin Pharmacol. 1984; 17:223-4P.

136. Westra P, Houwertjes C, Wesseling H et al. Bile salts and neuromuscular blocking agents. Br J Anaesth. 1981; 53:407-15. https://pubmed.ncbi.nlm.nih.gov/6112011

137. Cronnelly R. Reversal agents after vecuronium and other competitive muscle relaxants. In: Agoston S, Bowman WC, Miller RD, Viby-Mogensen J, eds. Clinical experiences with Norcuron (Org NC 45, vecuronium bromide). Amsterdam: Excerpta Medica; 1983:79-84.

138. McIndewar IC, Marshall RJ. Interactions between the neuromuscular blocking drug Org NC45 and some anaesthetic, analgesic and antimicrobial agents. Br J Anaesth. 1981; 53:785-92. https://pubmed.ncbi.nlm.nih.gov/6115660

139. Rutten JMJ, Booij LHDJ, Rutten CLJ et al. The comparative neuromuscular blocking effects of some aminoglycoside antibiotics. Acta Anaesthesiol Belg. 1980; 31:293-306. https://pubmed.ncbi.nlm.nih.gov/6111886

140. Krieg N, Ruten JMJ, Crul JF et al. Preliminary review of the interactions of Org NC 45 with anaesthetics and antibiotics in animals. Br J Anaesth. 1980; 52(Suppl 1):33-6S.

141. Reviewers’ comments (personal observations); 1985 Mar.

142. Schwarz S, Ilias W, Lackner F et al. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology. 1985; 62:388-91. https://pubmed.ncbi.nlm.nih.gov/2858993

143. Miller RD, Rupp SM, Fisher DM et al. Clinical pharmacology of vecuronium and atracurium. Anesthesiology. 1984; 61:444-53. https://pubmed.ncbi.nlm.nih.gov/6148907

144. Koenig RM. (Organon Inc, West Orange, NJ): Personal communication; 1985 Mar.

145. Conner CS. Atracurium and vecuronium: two unique neuromuscular blocking agents. Drug Intell Clin Pharm. 1984; 18:714-6. https://pubmed.ncbi.nlm.nih.gov/6148226

146. Burroughs Wellcome Co. Tracrium injection prescribing information. Research Triangle Park, NC; 1983 Dec.

147. Robertson EN, Booij LHDJ, Fragen RJ et al. Intradermal histamine release by 3 muscle relaxants. Acta Anaesthesiol Scand. 1983; 27:203-5. https://pubmed.ncbi.nlm.nih.gov/6192671

148. Fisher DM, Castagnoli K, Miller RD. Vecuronium kinetics and dynamics in anesthetized infants and children. Clin Pharmacol Ther. 1985; 37:402-6. https://pubmed.ncbi.nlm.nih.gov/2858278

149. Hunter JM, Jones RS, Utting JE. Comparison of vecuronium, atracurium and tubocurarine in normal patients and in patients with no renal function. Br J Anaesth. 1984; 56:941-51. https://pubmed.ncbi.nlm.nih.gov/6147153

150. Bencini A, Newton DEF. Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium. Br J Anaesth. 1984; 56:959-65. https://pubmed.ncbi.nlm.nih.gov/6147155

151. Bell CF, Hunter JM, Jones RS et al. Use of atracurium and vecuronium in patients with oesophageal varices. Br J Anaesth. 1985; 57:160-8. https://pubmed.ncbi.nlm.nih.gov/2857569

152. Buzello W, Schluermann D, Schindler M et al. Hypothermic cardiopulmonary bypass and neuromuscular blockade by pancuronium and vecuronium. Anesthesiology. 1985; 62:201-4. https://pubmed.ncbi.nlm.nih.gov/2857541

153. Miller RD. The priming principle. Anesthesiology. 1985; 62:381-2. https://pubmed.ncbi.nlm.nih.gov/3157331

154. Morris R, Giesecke AH. Potentiation of muscle relaxants by magnesium sulfate therapy in toxemia of pregnancy. South Med J. 1968; 61:25-8.

155. Ghoneim MM, Long JP. The interaction between magnesium and other neuromuscular blocking agents. Anesthesiology. 1970; 32:23-7. https://pubmed.ncbi.nlm.nih.gov/5460601

156. Shinn AF, Shrewsbury RP. Evaluations of drug interactions. 3rd ed. St. Louis: The CV Mosby Company; 1985:81.

157. Driessen JJ, Wuis EW, Gielen MJM. Prolonged vecuronium neuromuscular blockade in a patient receiving orally administered dantrolene. Anesthesiology. 1985; 62:523-4. https://pubmed.ncbi.nlm.nih.gov/2858994

158. Miles Pharmaceuticals. Mezlin prescribing information. West Haven, CT; 1986 Nov.

159. Tybra M. Wirkungsverstarkung nicht-depolarisierender Muskelrelaxantier durch Acylaminopenicilline: Untersuchungen am Beispeil von Vecuronium. (German; with English abstract.) Anaesthetist. 1985; 34:651-5.

160. Shanks CA, Avram MJ, Fragen RJ et al. Pharmacokinetics and pharmacodynamics of vecuronium administered by bolus and infusion during halothane or balanced anesthesia. Clin Pharmacol Ther. 1987; 42:459-64. https://pubmed.ncbi.nlm.nih.gov/2889555

161. Spence AG, Barnetson RS. Reaction to vecuronium bromide. Lancet. 1985; 1:979-80. https://pubmed.ncbi.nlm.nih.gov/2859430

162. O’Callaghan AC, Scadding G, Watkins J. Bronchospasm following use of vecuronium. Anaesthesia, 1986; 41:940-2.

163. American Academy of Pediatrics Committee on Fetus and Newborn and Committee on Drugs. Benzyl alcohol: toxic agent in neonatal units. Pediatrics. 1983; 72:356-8. https://pubmed.ncbi.nlm.nih.gov/6889041

164. Anon. Benzyl alcohol may be toxic to newborns. FDA Drug Bull. 1982; 12(2):10-1. https://pubmed.ncbi.nlm.nih.gov/7188569

165. Anon. Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982; 31:290-1. https://pubmed.ncbi.nlm.nih.gov/6810084

166. Anderson CW, Ng KJ, Andresen B et al. Benzyl alcohol poisoning in a premature newborn infant. Am J Obstet Gynecol. 1984; 148:344-6. https://pubmed.ncbi.nlm.nih.gov/6695984

167. Food and Drug Administration. Parenteral drug products containing benzyl alcohol or other antimicrobial preservatives; intent and request for information. [Docket No. 85N-0043] Fed Regist. 1985; 50:20233-5.

168. Burroughs Wellcome Co. Tracurium injection (atracurium besylate) prescribing information. Research Triangle Park, NC; 1989 Apr.

169. Mills AK, Martyn JAJ. Evaluation of atracurium neuromuscular blockade in paediatric patients with burns. Br J Anaesth. 1988; 60:450-5. https://pubmed.ncbi.nlm.nih.gov/3355741

170. Dwersteg JF, Pavlin EG, Heimbach DM. Patients with burns are resistant to atracurium. Anesthesiology. 1986; 65:517-20. https://pubmed.ncbi.nlm.nih.gov/3777482

171. Marathe PH, Dwersteg JF, Pavlin EG et al. Effect of thermal injury on the pharmacokinetics and pharmacodynamics of atracurium in humans. Anesthesiology. 1989; 70:752-5. https://pubmed.ncbi.nlm.nih.gov/2719307

172. Martyn J, Goldhill DR, Goudsouzian NG. Clinical pharmacology of muscle relaxants in patients with burns. J Clin Pharmacol. 1986; 26:680-5. https://pubmed.ncbi.nlm.nih.gov/2947935

173. Anon. Neuromuscular blockers in patients with burns. Lancet. 1988; 2:1003-4. https://pubmed.ncbi.nlm.nih.gov/2902437

174. Pavlin EG, Haschke RH, Marathe P et al. Resistance to atracurium in thermally injured rats: the roles of time, activity, and pharmacodynamics. Anesthesiology. 1988; 69:696-701. https://pubmed.ncbi.nlm.nih.gov/3189916

175. Mills AK, Martyn AJ. Neuromuscular blockade with vecuronium in paediatric patients with burn injuries. Br J Clin Pharmacol. 1989; 28:155-9. https://pubmed.ncbi.nlm.nih.gov/2570602

176. Martyn JA, Goudsouzian NG, Matteo RS et al. Metocurine requirements and plasma concentrations in burned paediatric patients. Br J Anaesth. 1983; 55:263-8. https://pubmed.ncbi.nlm.nih.gov/6220728

177. Martyn JA, Matteo RS, Szyfelbein SK et al. Unprecedented resistance to neuromuscular blocking effects of metocurine with persistence after complete recovery. Anesth Analg. 1982; 61:614-7. https://pubmed.ncbi.nlm.nih.gov/6212001

178. Martyn JA, Szyfelbein SK, Ali HH et al. Increased d-tubocurarine requirement following major thermal injury. Anesthesiology. 1980; 52:352-5. https://pubmed.ncbi.nlm.nih.gov/7362055

179. Martyn JA, Liu LM, Szyfelbein SK et al. The neuromuscular effects of pancuronium in burned children. Anesthesiology. 1983; 59:561-4. https://pubmed.ncbi.nlm.nih.gov/6316813

180. Martyn JA, Matteo RS, Greenblatt DJ et al. Pharmacokinetics of d-tubocurarine in patients with thermal injury. Anesth Analg. 1982; 61:241-6. https://pubmed.ncbi.nlm.nih.gov/7199837

181. Leibel WS, Martyn JA, Szyfelbein SK et al. Elevated plasma binding cannot account for the burn-related d-tubocurarine hyposensitivity. Anesthesiology. 1981; 54:378-82. https://pubmed.ncbi.nlm.nih.gov/7224206

182. Storella RJ, Martyn JA, Bierkamper GG. Anti-curare effect of plasma from patients with thermal injury. Life Sci. 1988; 43:35-40. https://pubmed.ncbi.nlm.nih.gov/2968490

183. Kim C, Fuke N, Martyn JAJ. Burn injury to rat increases nicotinic acetylcholine receptors in the diaphragm. Anesthesiology. 1988; 68:401-6. https://pubmed.ncbi.nlm.nih.gov/3344995

184. Marathe PH, Haschke RH, Slattery JT et al. Acetylcholine receptor density and acetylcholinesterase activity in skeletal muscle of rats following thermal injury. Anesthesiology. 1989; 70:654-9. https://pubmed.ncbi.nlm.nih.gov/2930003

185. Dupuis JY, Martin R, Tetrault JP. Atracurium and vecuronium interaction with gentamicin and tobramycin. Can J Anaesth. 1989; 36:407-11. https://pubmed.ncbi.nlm.nih.gov/2569365

186. 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; 327:524-8. https://pubmed.ncbi.nlm.nih.gov/1353252

187. Gazmuri RJ, Hanif S, Wagner D. Persistent paralysis after vecuronium administration. N Engl J Med. 1992; 327:1881-2. https://pubmed.ncbi.nlm.nih.gov/1360146

188. Kupfer Y, Namba T, Kaldawi E et al. Prolonged weakness after long-term infusion of vecuronium bromide. Ann Intern Med. 1992; 117:484-6. https://pubmed.ncbi.nlm.nih.gov/1354426

189. Bernstein D. Prolonged weakness and vecuronium. Ann Intern Med. 1993; 118:569. https://pubmed.ncbi.nlm.nih.gov/8095130

190. Hirano M, Raps EC, Cowen J. Prolonged weakness and vecuronium. Ann Intern Med. 1993; 118:570. https://pubmed.ncbi.nlm.nih.gov/8318072

191. Barnette RE, Carlsson C. Prolonged weakness and vecuronium. Ann Intern Med. 1993; 118:570-1. https://pubmed.ncbi.nlm.nih.gov/8442630

192. Kupfer Y, Namba T, Tessler S. Prolonged weakness and vecuronium. Ann Intern Med. 1993; 118:570-1.

193. Anon. Neuromuscular blocking agents norcuron and tracrium should bear warnings on prolonged paralysis in ICU use; monitoring strongly suggested by FDA committee. F-D-C Rep. 53:17-8.

249. ASHP. Standardize 4 Safety: pediatric continuous infusion standard. Updated 2024 Jun. From ASHP website. Updates may be available at ASHP website. https://www.ashp.org/standardize4safety

250. ASHP. Standardize 4 Safety: adult continuous infusion standard. Updated 2024 Mar. From ASHP website. Updates may be available at ASHP website. https://www.ashp.org/standardize4safety

340. Merck & Co., Inc. Bridion (sugammadex) injection prescribing information. Whitehouse Station, NJ; 2016 Oct.

341. Society of Critical Care Medicine and American Society of Health-System Pharmacists. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Am J Health-Syst Pharm. 2002; 59:179-95. https://pubmed.ncbi.nlm.nih.gov/11826571

343. Khuenl-Brady KS, Wattwil M, Vanacker BF et al. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010; 110:64-73. https://pubmed.ncbi.nlm.nih.gov/19713265

345. Lemmens HJ, El-Orbany MI, Berry J et al. Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. BMC Anesthesiol. 2010; 10:15. https://pubmed.ncbi.nlm.nih.gov/20809967

355. Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology. 1992; 77:785-805. https://pubmed.ncbi.nlm.nih.gov/1416176

356. Srivastava A, Hunter JM. Reversal of neuromuscular block. Br J Anaesth. 2009; 103:115-29. https://pubmed.ncbi.nlm.nih.gov/19468024

357. Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010; 111:129-40. https://pubmed.ncbi.nlm.nih.gov/20442261

358. Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010; 111:120-8. https://pubmed.ncbi.nlm.nih.gov/20442260

359. Institute for Safe Medication Practices. Paralyzed by mistakes: reassess the safety of neuromuscular blockers in your facility. ISMP Medication Safety Alert! Acute Care edition. Horsham, PA; 2016 June. From ISMP website http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1141

420. McManus MC. Neuromuscular blockers in surgery and intensive care, part 1. Am J Health-Syst Pharm. 2001; 58:2287-99. https://pubmed.ncbi.nlm.nih.gov/11763807

421. McManus MC. Neuromuscular blockers in surgery and intensive care, part 2. Am J Health-Syst Pharm. 2001; 58: 2381-99. https://pubmed.ncbi.nlm.nih.gov/11794954

422. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009; 64 Suppl 1:10-21. https://pubmed.ncbi.nlm.nih.gov/19222427

423. Murray MJ, DeBlock H, Erstad B et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016; 44:2079-2103. https://pubmed.ncbi.nlm.nih.gov/27755068

424. Hampton JP. Rapid-sequence intubation and the role of the emergency department pharmacist. Am J Health Syst Pharm. 2011; 68:1320-30. https://pubmed.ncbi.nlm.nih.gov/21719592

425. Institute for Safe Medication Practices. 2018-2019 Targeted medication safety best practices for hospitals. Horsham, PA; 2017 Dec. From ISMP website https://www.ismp.org/sites/default/files/attachments/2017-12/TMSBP-for-Hospitalsv2.pdf

HID. Trissel LA. Handbook on injectable drugs. 18th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2015: 1152-4.

b. AHFS Drug Information 2018. McEvoy GK, ed. Neuromuscular blocking agents general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2018.

Medical Disclaimer