Vecuronium
Structural formula | ||||||||||||||||||||||
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Non-proprietary name | Vecuronium | |||||||||||||||||||||
other names |
[(2 S , 3 S , 5 S , 8 R , 9 S , 10 S , 13 S , 14 S , 16 S , 17 R ) -3-acetyloxy-10,13-dimethyl-16- (1-methylpiperidine- 1-ium-1-yl) -2-piperidin-1-yl-2,3,4,5,6,7,8,9,11,12,14,15,16,17-tetradecahydro-1 H - cyclopenta [ a ] phenanthren-17-yl] acetate bromide ( IUPAC ) |
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Molecular formula | C 34 H 57 BrN 2 O 4 | |||||||||||||||||||||
Brief description |
odorless, white, crystalline powder |
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Drug information | ||||||||||||||||||||||
ATC code | ||||||||||||||||||||||
Drug class |
Muscle relaxant |
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properties | ||||||||||||||||||||||
Molar mass | 637.73 g · mol -1 | |||||||||||||||||||||
Physical state |
firmly |
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Melting point |
228 ° C |
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boiling point |
from 350 ° C decomposition |
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safety instructions | ||||||||||||||||||||||
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As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions . |
Vecuronium is the non-proprietary name (INN) for a non-depolarizing, medium long-acting muscle relaxant that has been introduced into clinical practice 1980th It represents a further development of the long-acting pancuronium and, like this, belongs to the group of amino steroids . In contrast to the pancuronium, the vecuronium has only one quaternary amine center ( mono-quaternary relaxant ) at a physiological pH value .
The bromide is used pharmaceutically .
Pharmacological properties
Vecuronium is a potent muscle relaxant, the effective dose for a 95% effect (ED 95 ) is 0.05 mg / kg body weight. The attack time after a usual intubation dose (double ED 95 ) is 2-3 minutes, the clinical duration of action after a single dose is 30-40 minutes. The volume of distribution is determined by the hydrophilicity small of the molecule as in the other non-depolarizing muscle relaxants and amounts to 0.2-0.5 liters per kg of body weight. The plasma clearance is 2.5–5 ml / kg body weight / min.
About 30% of the vecuronium is excreted via the kidneys , the rest via the biliary route, some of which is converted into metabolites by the liver . This results in 3-hydroxy-, 3,17-hydroxy- and 17-hydroxyvecuronium, of which the former shows a 50% potency, while the other metabolites are hardly effective. The duration of action may be prolonged with repeated or continuous administration, mainly due to the accumulation of the 3-hydroxy metabolite. This can also be the case with liver failure , although this only plays a minor role after a single dose. A renal failure will not affect the duration of action.
application
Vecuronium is used as a non-depolarizing muscle relaxant to create good intubation conditions (for endotracheal intubation ) during induction of anesthesia and / or for surgical interventions that require relaxation of the skeletal muscles . Vecuronium (bromide) is supplied as a soluble powder ( lyophilisate ) that is dissolved in water for use; As this simplifies storage and does not require cooling, Vecuronium is often used in emergency medicine . However, it is not suitable for rapid sequence induction , which limits its application.
There is an incompatibility with the barbiturate thiopental , so that these active ingredients have to be administered separately.
In the US states of Florida and Oklahoma , vecuronium is said to be used together with hydromorphone and potassium chloride for execution after the usual barbiturates were no longer available. In April 2014, the first such execution in McAlester State Prison failed spectacularly.
Side effects
The side effect profile corresponds to that of other non-depolarizing muscle relaxants; Independent breathing of the patient is no longer possible due to the complete paralysis of the skeletal muscles, which is why airway protection and controlled ventilation must be carried out. Vecuronium is characterized by circulatory stability and has almost no blocking effects on muscarinic acetylcholine receptors (no vagolysis , no triggering of tachycardia ). Also, no relevant histamine release is caused.
Application restrictions
Although Vecuronium does not cross the placenta , there are no studies in humans for safety during pregnancy, so its use is not recommended. However, it can be used in children.
Trade names
Vecuronium is commercially available as a bromide in Germany, Austria and Switzerland under the name Norcuron and in Germany also as a generic.
literature
- Rossaint, Werner, Zwissler (ed.): The anesthesiology. General and special anesthesiology, pain therapy and intensive care medicine. Springer, Berlin; 2nd edition 2008. ISBN 978-3-540-76301-7
- Heck, Fresenius: Revision course anesthesiology . Springer, Berlin; 5th edition 2007. ISBN 978-3-540-46575-1
- Technical information for Norcuron ®
Individual evidence
- ↑ a b c d F. v. Bruchhausen, S. Ebel, AW Frahm, E. Hackenthal: Hagers Handbook of Pharmaceutical Practice. 5th edition, Vol. 7, fabrics A – D, Springer / Birkhäuser, 1995, ISBN 978-3-540-52688-9 , p. 97.
- ↑ a b c Entry on Vecuronium in the ChemIDplus database of the United States National Library of Medicine (NLM) .
- ↑ a b Data sheet Vecuronium bromide from Sigma-Aldrich , accessed on April 25, 2011 ( PDF ).
- ↑ Anesthesia and Analgesia Vol. 66, p. 188, 1987.
- ^ British Journal of Anesthesia. Vol. 57, pp. 807, 1985.
- ↑ Oklahoma plans to use untested three-drug combination in two executions. The Guardian, April 1, 2014 .
- ↑ Oklahoma blames inmate's vein for botched execution; attorney questions 'untried' lethal injection. AP, April 30, 2014.
- ↑ An execution stirs up the United States. Tages-Anzeiger, May 3, 2014.