| Drug |
Metabolism |
Histamine Release |
Active Metabolism |
Special |
| d-Tubocurarine |
Renal 45%
Biliary 10-40% |
+++ |
|
Useful in Liver Failure |
| Atracurium |
-Ester Hydrolysis 2/3
-Hoffman Elimination |
+
Attenuated by injection over 1-3 min. |
Laudanosine
CNS Stimulant |
|
| Cisatracurium (Nimbex) |
-Hoffman Elimination
-Less on Ester Hydrolysis |
|
-Laudanosine
-5 Fold less than Atracurium |
-More potent than Atracurium
-Devoid of Histamine release |
| Mivacurium |
Ester Hydrolysis |
+
With rapid infusion of 3X ED95 |
|
Reversal may not be necessary |
Pancuronium
0.1 mg/kg |
Exc. -Renal 80%
-Hepatic 10-40%
-Biliary 20% |
|
3-OH Pancuronium
-50% as potent as parent compound |
-Vagolytic
-Cheapest
-Ø MAC 25% |
| Pipecuronium |
Exc.-Renal 70%
-Hepatic 10%
-Biliary 20% |
|
|
No Cardiovascular effects |
| Doxacurium |
Exc.-Renal 70%
-Biliary 30%
-Minimal Hydrolysis in Plasma |
|
|
Useful inpatients with CAD for prolonged Anesth. or Mech. Vent. |
Rocuronium
(Zemuron) |
Exc.-Biliary 50-70%
-Renal 10-25%
-Hepatic 10-20% |
|
|
Onset 60 Sec. With 2X ED95 |
| Vecuronium |
Exc.-Biliary 40-75%
-Renal 15-25%
-Hepatic 20-30% |
|
3-OH Vecuronium
-60% as active as vecuronium |
-Useful in patients with CAD
-Useful in ESRD |
Liver Disease: Prolong: Pancuronium, d-Tubocurarine,
Normal: Atracurium and Vecuronium, Sux. Prolonged in theory but not in practice. |
