Agents for Medical Paralysis

Agent

Mechanism

Intubating Dose (mg/kg) IV

Infusion Dose (ug/kg/min)

Duration of effect (min)

Elimination

Succinylcholine

Depolarizing

1

NA

4 - 6

Plasma cholinesterase

Vercuronium

Non-depolarizing

0.1 - 0.3

1 – 2

25-30

20% renal 80% hepatic

Pancuronium

Non-depolarizing

0.08 - 0.1

0.2 – 0.5

80 – 100

80% renal 20% hepatic

Cis-atracurium

Non-depolarizing

0.4 – 0.5

2 – 4

50 – 60

Hoffmann (non-renal non- hepatic)

 Blue hyperlinks are PDR-type drug references.  

NOTE:  IT IS UT PULMONARY / CRITICAL CARE INSTITUTIONAL POLICY THAT PARALYTIC AGENTS CAN NOT BE USED WITHOUT THE APPROVAL OF THE MICU FELLOW OR ATTENDING PHYSICIAN.  

In general, succinylcholine is the preferred agent for rapid-sequence intubation, but should be avoided in patients with  or at risk for hyperkalemia.  Vercuronium is preferred for long term paralysis in patients with hemodynamic instability.  Cis-atracuriumis a good agent for patients with renal or liver failure; however, remember that it is extremely expensive. 

Patients with long-term paralysis from cis-atracurium recover neuromuscular function following termination of infusion in approximately 55 minutes (range: 20 to 270) whereas vecuronium-treated patients recover in 178 minutes (range: 40 minutes to 33 hours).  (PDR) 

There is data published that indicates that the use of long-term medical paralysis may put patients at risk for the development of myopathies, particularly in those concurrently receiving corticosteroids or aminoglycoside antibiotics.  Therefore, it is best to discontinue the use of paralytic agents as soon as the patient’s condition will allow.

Developed by S.E. Spencer, MD   4/17/00               copyright © UT Memphis, 2000

 

E-mail contact for UT Pulmonary / Critical Care Website:   S. Spencer, MD
Last Updated: 09/16/02
Disclaimer, Internet Technology Policy, Network Publishing Guidelines, UT Home Page
The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution.