Pharmacokinetics
Pancuronium's duration of action is approximately 45 to 60 minutes.11 An average duration of action is 42 minutes following mean doses of intravenous pancuronium of 2.7 mg.11 Following a single 0.05 mg/kg intravenous pancuronium dose, the 50% recovery time was 37 minutes.11.
Peak onset of action is at 2–3 minutes.12
Divided doses of pancuronium may be advantageous in providing rapid, intense paralysis.13
Pancuronium has been associated with haemodynamic effects (e.g. tachycardia, hypertension) due to blockade of cholinergic receptors outside the neuromuscular junction.6
Recovery time after paralysis with continuous infusion is faster than that after intermittent bolus injection.7
A prospective, open-label study conducted in 25 children receiving continuous infusions of pancuronium in ICU showed increased infusion requirement for patients requiring > 5 days treatment or for those receiving concomitant anticonvulsant therapy.8
Safety
Prolonged administration of pancuronium during the neonatal period is associated with sensorineural hearing loss in childhood survivors of CDH.4
Pancuronium has been associated with prolonged paralysis and muscle atrophy after 1 week when given as intermittent doses or by continuous infusion.5
In premature infants, pancuronium has also been associated with joint contractures, specifically in the hips and knees.6 However, this effect does not appear to persist after discontinuation of the drug and resumption of spontaneous activity.6
Newborn infants paralysed with pancuronium, despite fluid restriction, had evidence of fluid retention and were significantly heavier that the control infants from day 3 onwards and above their birth weight by day 7. Strict attention to fluid retention is essential when newborns are treated with pancuronium.17 (LOE III GOR C)
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