維庫溴銨
**維庫溴銨 (Vecuronium bromide)** 是一種中效、合成的氨基類固醇**非去極化型神經肌肉阻斷劑**。 主要臨床特徵包括： * **手術輔助**：主要作為全身麻醉的輔助藥物，以產生深度的骨骼肌鬆弛。 * **促進醫療處置**：非常適合用於協助氣管插管、機械尋氣以及精細的外科手術（例如眼科或骨科手術）。 * **心血管穩定性**：與某些其他神經肌肉阻斷劑不同，它對心血管的影響極小，且通常不會引發組織胺釋放。 * **鳥類應用**：曾被局部應用於鳥類以誘發散瞳（瞳孔放大），因為鳥類的虹膜含有橫紋肌。 > **重要臨床提示**：維庫溴銨**不具備任何鎮痛、鎮靜或失憶特性**。它會麻痺所有骨骼肌，包括橫膈膜。在給藥前及給藥期間，病患必須處於完全麻醉、無意識狀態，並接受正壓機械通氣。
作用機制: Vecuronium acts as a competitive antagonist at the **nicotinic cholinergic receptors (nAChRs)** located at the **motor endplate** of the neuromuscular junction. * **Mechanism**: Vecuronium binds to the alpha subunits of the nAChR → prevents **acetylcholine (ACh)** from binding → inhibits depolarization of the muscle fiber → results in **flaccid paralysis**. * **Potency**: It is highly potent, estimated to be equipotent to up to 3 times as potent as pancuronium on a weight basis, but with a shorter duration of action (approximately ⅓ to ½ as long).
各物種劑量
- Muscle relaxation during anesthesia · 20-40 micrograms/kg (0.02-0.04 mg/kg) · IV
- Neuromuscular blockade (loading dose) · 0.1 mg/kg · IV · initially · Produces blockade for 25-30 min · Lower loading dose of 0.05 mg/kg IV produces shorter duration (16-19 min).
- Neuromuscular blockade (maintenance) · 0.03 mg/kg increments OR 0.1-0.2 mg/kg/h · IV · PRN or CRI · As needed during surgery · Repeated doses are relatively non-cumulative in healthy animals.
- Muscle relaxation during anesthesia · 0.1 mg/kg · IV · initially (after meperidine and/or acepromazine pre-op 30 minutes before); may give subsequent incremental doses of 0.04 mg/kg · Duration of action after initial dose averages 25 minutes.
- Muscle relaxation during anesthesia · 10-20 micrograms/kg · IV
- Muscle relaxation (CRI maintenance with propofol-fentanyl) · 0.2 mg/kg/hr · IV · CRI
- Muscle relaxation (CRI maintenance with fentanyl-isoflurane or fentanyl-sevoflurane) · 0.1 mg/kg/hr · IV · CRI
- Neuromuscular blockade (loading dose) · 0.1 mg/kg · IV · initially · Produces blockade for 25-30 min · Lower loading dose of 0.05 mg/kg IV produces shorter duration (16-19 min).
- Neuromuscular blockade (maintenance) · 0.03 mg/kg increments OR 0.1-0.2 mg/kg/h · IV · PRN or CRI · As needed during surgery · Repeated doses are relatively non-cumulative in healthy animals.
給藥途徑
禁忌症
- Known hypersensitivity to vecuronium or bromides
- Conscious or inadequately anesthetized animals
- Lack of facilities for positive pressure ventilation/mechanical ventilation
- Severe hepatic dysfunction (relative contraindication; atracurium preferred)
不良反應
- Profound, prolonged musculoskeletal paralysis (pharmacologic effect)
- Skeletal muscle weakness
- Respiratory arrest (if mechanical ventilation is not provided)
- Prolonged apnea (expected pharmacological effect)
- No cardiovascular effects or histamine release reported at clinical doses
藥物相互作用
- Other Non-Depolarizing Muscle Relaxants · May have a synergistic effect if used concurrently with vecuronium.
- Succinylcholine · May speed the onset of action and enhance the neuromuscular blocking actions of vecuronium; do not give vecuronium until succinylcholine effects have subsided.
- Aminoglycosides · May enhance or prolong the neuromuscular blocking activity. · major
- Inhalant Anesthetics (Halothane, Isoflurane, Sevoflurane) · May enhance or prolong the neuromuscular blocking activity.
- Clindamycin, Lincomycin · May enhance or prolong the neuromuscular blocking activity.
- Dantrolene · May enhance or prolong the neuromuscular blocking activity.
- Magnesium Salts · May enhance or prolong the neuromuscular blocking activity.
- Piperacillin, Mezlocillin · May enhance or prolong the neuromuscular blocking activity.
- Quinidine · May enhance or prolong the neuromuscular blocking activity.
- Tetracyclines · May enhance or prolong the neuromuscular blocking activity.
- Verapamil · May enhance or prolong the neuromuscular blocking activity.
- Volatile anaesthetics · Prolonged neuromuscular blockade · major
監測
- Level of neuromuscular relaxation (using a peripheral nerve stimulator/train-of-four monitor)
- Heart rate, blood pressure, and ECG
- SpO2 and End-tidal CO2 (capnography)
- Core body temperature
- Neuromuscular function (Peripheral nerve stimulator / Train-of-Four)
- Continuous respiratory monitoring (Capnography/ETCO2, SpO2)
- Heart rate and blood pressure
- Acid-base and electrolyte status (especially potassium)
過量
No cases of vecuronium overdosage have been reported in human or veterinary medicine. **Treatment of Overdose**: * Treat conservatively with **mechanical ventilation**, oxygen therapy, and IV fluids until the block wears off naturally. * **Pharmacologic Reversal**: Blockade can be reversed using an **anticholinesterase agent** (e.g., edrophonium, physostigmine, or neostigmine) combined with an **anticholinergic** (atropine or glycopyrrolate) to prevent severe bradycardia and excessive salivation. * *Suggested Reversal Protocol*: Neostigmine **0.06 mg/kg IV** administered after Atropine **0.02 mg/kg IV**.
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