Temperature-dependent Pharmacokinetics and Pharmacodynamics of Vecuronium

Abstract

Our results show that reduced clearance and rate of effect site equilibration explain the increased duration of action of vecuronium with reducing core temperature. Tissue sensitivity to vecuronium is not influenced by core temperature.

Residual Neuromuscular Blockade in Critical Care

“…Adverse events such as RNMB may be more prevalent than previously documented. 32 Any transfer of a patient who has received an NMBA should include handoff information about the NMBA administered and the results of monitoring to provide essential data for the basis of ongoing assessments. Critical care nurses must be aware of the importance of monitoring patients given NMBAs, the agents used to reverse blockade, and the risks and adverse outcomes associated with the blocking agents.…”

“…These effects may be attributed to alterations in the cytochrome P450 enzyme system. [31][32][33][34] Vecuronium is an NMBA of intermediate duration that undergoes hepatic metabolism by cytochrome P450 enzymes.…”

“…28,[30][31][32] Hypothermia also plays a role in pharmacokinetic changes that occur with other NMBAs. Rocuronium is structurally similar to vecuronium, with a slightly faster onset of action and lower potency.…”

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

“…Drug effects are prolonged because of decreased metabolism and increased potency secondary to decreased body temperature [6]. For example, the clearance of midazolam and vecuronium is reduced approximately 11% for every degree Celsius drop in body temperature [7,8]. Similarly, the metabolism of remifentanil is reduced by approximately 6% for every one degree Celsius drop in temperature [9].…”

“…The only exceptions to the SCIP measure are documentation of intentional hypothermia, monitored anesthesia care, or peripheral nerve block [1]. The SCIP measure was created because intraoperative hypothermia has been associated with an increase in surgical site infections (SSIs), post-operative cardiac events, intraoperative blood loss, transfusion requirements, time to recover from anesthesia, and a decrease in the metabolism of common anesthetics [5][6][7][8][9][10][11][12][13].…”