Dose:   0.1 mg/kg (100 mcg/kg) IV as a single dose or a loading dose
             0.05 to 0.1 mg/kg/hr (50 to 100 mcg/kg/hour) as a continuous infusion

Frequency:  Q 1 to 2 hours or as a continuous infusion

Comments: Vecuronium is a "steroidal" nondepolarizing neuromuscular blocking agent (NMB) with an intermediate duration of action.  Vecuronium was introduced into the NICU in the 1980s as an alternative to pancuronium because vecuronium has limited effects on the cardiovascular system. Its duration of action is shorter than pancuronium (30 to 100 minutes) though the time to produce paralysis is similar (one to four minutes).  The duration will be increased with increasing doses. The drug is metabolized in the liver. There is an accumulation of the drug following a continuous infusion of as little as 3 hours. This is more likely to occur in preterm infants. Though the effects of paralysis can be reversed (using atropine 0.01 to 0.03 mg/kg/dose followed by neostigmine 0.06 mg/kg/dose), paralysis may redevelop particularly following repeated dosing, large doses, or continuous infusions.  See NMB Table for comparison with other NMB agents. The principle danger in using vecuronium is the inadvertent development of hypoxemia or hypoventilation in the infant. Sometimes it is difficult to determine the extent to which the infant is dependent upon his own respiratory drive until after the drug is administered. If this proves to be a significant component, then one must be ready to increase ventilator support or to reverse the neuromuscular blockade immediately.  More comments on vecuronium.

Preparation: Vecuronium (Norcuron) will be prepared in the pharmacy in a 50 mg/50 ml bag to be used with a programmable infusion pump and Mangum set. Order the vecuronium infusion "1 mg/ml at ___ mcg/hour providing ____ mcg/kg/hour." Use the drip sheet pre 8/12 (need excel on computer) or the drip sheet after 8/12 or the vecuronium check sheet (page will print off any computer)  to double check the rate calculated by the programmable pump. Please give pharmacy 2 hours to prepare a refill. Vecuronium infusions prepared by the pharmacy are stable for up to 96 hours. Vecuronium prepared in the NICU should be discarded after 24 hours.

Link to Information about preparing Vecuronium and vecuronium drip without using programable pumps.

Compatibility: It is compatible with TPN, no information available on filter. Compatible with D5W, D5NS, LR, NS, aminophylline, cefazolin, dobutamine, dopamine, epinephrine, esmolol, fentanyl, fluconazole, gentamicin, heparin,  hydrocortisone, isoproterenol, labetalol, lorazepam, midazolam, morphine, nitroprusside, propofol, ranitidine, trimethoprim-sulfamethoxazole, and vancomycin.  It is incompatible with diazepam, furosemide, and phenobarbital.