Vecuronium

This steroid-based molecule has a similar potency to pancuronium. It possesses good cardiovascular stability and does not release histamine. As a drug with an intermediate duration of action, it is suited to administration by infusion and is popular in many ICUs. Vecuronium is metabolized in the liver and, together with its metabolites (one of which, 3-hydroxy vecuronium, is also a neuromuscular blocker with a potency about 70 per cent of that of vecuronium), is eliminated in the urine. Therefore its action is extended in patients with renal insufficiency and there are reports of cases where recovery from a block has taken many hours (or even days) following an infusion of vecuronium in the presence of renal failure.

Evidence has been accumulating with respect to a possible deleterious effect of vecuronium when given by prolonged infusion in the ICU. Critically ill patients often develop a myopathy as a result of their disease process. This seems to be made worse by the use of a steroid relaxant. However, this so-called 'steroid myopathy' is not clearly understood, and some doubt its existence or disagree over its significance.

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