Indications & Uses
Survec is an adjunct to general anaesthesia, used to aid endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Dosage The recommended initial dose of Vecuronium is 0.08 to 0.10 mg per kg body weight, given as an intravenous bolus injection. This dose can be expected to produce good or excellent conditions for non emergency intubation within 2.5 to 3.0 minutes after injection. In caesarean section and neonatal surgery the dose should not exceed 0.1 mg/kg. Like other neuromuscular blocking agents, Vecuronium Bromide should only be given by, or under the supervision of, experienced clinicians who are familiar with the action and use of these agents, and the dose should be individualized for each patient. Accordingly, adjustments should be made by giving smaller maintenance doses at less frequent intervals, or by using lower infusion rates, during long lasting procedures of more than one hour under inhalational anaesthesia. In adult patients the following dosage recommendations may serve as a general guideline for tracheal intubation and muscle relaxation in surgical procedures of short to long duration. Tracheal intubation. The standard intubating dose during routine anaesthesia is 0.08 to 0.1 mg Vecuronium Bromide per kg body weight, after which adequate intubation conditions are established within 90 to 120 seconds in nearly all patients. Dosage for surgical procedures after intubation with suxamethonium. If suxamethonium is used for intubation, the administration of Vecuronium should be delayed until the patient has clinically recovered from the neuromuscular block caused by suxamethonium. The recommended dose is 0.03 to 0.05 mg Vecuronium Bromide per kg body weight. Maintenance dosing. The recommended maintenance dose is 0.02 to 0.03 mg Vecuronium Bromide per kg body weight. These maintenance doses are best given when twitch height has recovered to 25 percent of the control twitch height. Dose requirements for continuous infusion. If Vecuronium is given by continuous infusion, it is recommended to give a loading dose of 0.08 to 0.1 mg Vecuronium Bromide per kg body weight first, and to start the infusion once the neuromuscular block begins to recover. The infusion rate should be adjusted to maintain the twitch response at 10 percent of the control twitch height, or to maintain 1 to 2 responses to train of four stimulation. In adults, the infusion rate needed to maintain neuromuscular block at this level ranges from 0.8 to 1.4 microgram Vecuronium Bromide per kg per minute. Repeat monitoring of the neuromuscular block is recommended, since infusion rate requirements vary from patient to patient and with the anaesthetic method used. Dosing in elderly patients. The same intubation and maintenance doses used in younger adults, 0.08 to 0.1 mg/kg and 0.02 to 0.03 mg/kg respectively, can be used. The onset time in elderly patients is similar to that in younger adults. Dosing in paediatric patients. In neonates up to 4 weeks and children up to 4 months, an initial test dose of 0.01 to 0.02 mg/kg is recommended, followed by incremental doses until 90 to 95 percent depression of the twitch response is achieved. In neonatal surgery the dose should not exceed 0.1 mg/kg. In children from 5 months to 10 years, the dose is 0.08 to 0.1 mg/kg, though children under 12 months tend to have a more rapid onset and may not need the full intubating dose. Maintenance in this age group is 0.02 to 0.03 mg/kg, adjusted according to response. Because the duration of action is shorter in children, maintenance doses are needed more frequently. Dosing in overweight and obese patients. Doses in overweight or obese patients should be reduced, taking ideal body weight into account. Initial doses ranging from 0.15 mg up to 0.30 mg Vecuronium Bromide per kg body weight have been given during surgery under both halothane and neurolept anaesthesia.
Side Effects
Survec belongs to the non-depolarising group of muscle relaxants and works over an intermediate duration. It does not typically trigger histamine release and has little effect on the cardiovascular system. As with other non-depolarising muscle relaxants, common side effects include flushing of the skin, low blood pressure, a fast heart rate, and bronchospasm, with anaphylactoid reactions occurring only very rarely. Acute myopathy has also been reported following prolonged use in intensive care settings.
Cautions & Contraindications
Warnings & Precautions
Allergic cross-reactivity between neuromuscular blocking agents has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, therefore lower doses are required. Non-depolarising muscle relaxants should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance may develop in patients with burns who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. General: Survec should be administered in carefully adjusted dosage by or under the supervision of experienced clinicians who are familiar with its actions and the possible complications that might occur following its use. The drug should not be administered unless facilities for intubation, artificial respiration, oxygen therapy, and reversal agents are immediately available. The clinician must be prepared to assist or control respiration. A peripheral nerve stimulator should be employed to monitor drug response, need for additional relaxant, and adequacy of spontaneous recovery or anticholinesterase antagonism.Intensive Care Unit: To reduce the possibility of prolonged neuromuscular blockade and other complications that might occur following long-term use in the ICU, Survec or any other neuromuscular blocking agent should be administered in carefully adjusted doses by or under the supervision of experienced clinicians who are familiar with its actions and with appropriate peripheral nerve stimulator muscle monitoring techniques.Neuromuscular Disease: In patients who are known to have myasthenia gravis or the myasthenic syndrome, small doses of Survec may have profound effects. In such patients, a peripheral nerve stimulator and use of a small test dose may be of particular value in assessing and monitoring dosage requirements.
Contraindications
Hypersensitivity to vecuronium bromide, the bromide ion, or any of its excipients is a contraindication to its use.