MDose · Veterinary drug reference
TIER2 TOPIC: NEUROMUSCULAR BLOCKERS (ATRACURIUM / PANCURONIUM / ROCURONIUM)
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Pending clinical review (PROPOSED)Rule-based (RULE_BASED)— applies to the facts and dose entries in this species selection; individual source records retain their own status.
Indications2
Muscle relaxation adjunct to general anesthesia (surgery, mechanical ventilation, facilitation of endotracheal intubation); paralyzing critically ill patients who tolerate minimal/no inhalant anesthesia
DogCatExtra-label (EXTRA_LABEL)2 source records · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Muscle relaxation adjunct to general anesthesia (surgery, mechanical ventilation, facilitation of endotracheal intubation); paralyzing critically ill patients who tolerate minimal/no inhalant anesthesia — Extra-label/hospital-use (human drugs)
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Muscle relaxation adjunct to general anesthesia (surgery, mechanical ventilation, facilitation of endotracheal intubation); paralyzing critically ill patients who tolerate minimal/no inhalant anesthesia — Extra-label/hospital-use (human drugs)
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Dose regimens0
No dose regimens recorded for this species selection.
Adverse effects4
Apnea/respiratory paralysis — by design: ventilation mandatory — Absolute requirement
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pancuronium: tachycardia, ↑BP, hypersalivation (anticholinergic pre-treat) — Expected profile
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Histamine release (atracurium < tubocurarine; pancuronium rare) — Hypotension/hypersensitivity
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Prolonged weakness (overdose/repeat dosing, renal failure + pancuronium) — Monitoring-driven
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Monitoring1
Clinical: Mechanical ventilation + pulse oximetry/capnography mandatory; peripheral nerve stimulator (train-of-four) to titrate; depth-of-anesthesia assurance separate from paralysis
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Monitoring Parameters · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Contraindications1
NEVER as sole agent — no analgesia, no sedation, no amnesia: a paralyzed awake patient feels everything; myasthenia gravis (relative — extreme sensitivity); hypersensitivity
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Precautions5
Pancuronium in renal failure (atracurium instead); tachycardia-sensitive patients (pancuronium); peripheral nerve stimulator monitoring recommended
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
The cardinal rule: paralytic ≠ anesthetic — unconsciousness and analgesia must be independently provided; the paralyzed-awake patient is the catastrophe this class can create.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Drug-picking logic: renal/hepatic failure → atracurium (organ-independent clearance); tachydysrhythmia risk → avoid pancuronium (vagolytic); need it FAST (RSI) → rocuronium.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Reversal ritual: atropine FIRST (0.02 mg/kg IV), then neostigmine (0.06 mg/kg IV) — cholinesterase inhibition floods muscarinic receptors too; the anticholinergic pre-dose prevents bradycardia/salivation crisis.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Train-of-four monitoring replaces clock-guessing — especially q20–30 min dosing limits in critical patients.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Interactions4
Aminoglycosides, magnesium, lidocaine, inhalants — Potentiate blockade
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Anticholinesterases (neostigmine 0.06 mg/kg IV after atropine 0.02 mg/kg, edrophonium) — REVERSAL agents
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Azathioprine — May reverse pancuronium blockade
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Succinylcholine — Sequential-use considerations
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pharmacokinetics4
Mechanism (all) — Competitive blockade of ACh receptors at the motor endplate — non-depolarizing (no fasciculations)
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Atracurium — Organ-independent elimination (Hofmann degradation/ester hydrolysis) → the renal/hepatic-failure choice; ¼–⅓ pancuronium potency; minimal CV effects; less histamine than tubocurarine
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pancuronium — 40% renal unchanged (t½ doubles in renal failure — pick atracurium); vagolytic → HR/BP bump; onset 2–3 min, duration 30–45 min
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Rocuronium — Fastest non-depolarizer (2–3× vecuronium onset; near-succinylcholine speed with fewer adverse effects); hepatic elimination; aqueous-stable; no MH induction; mild vagolysis
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pregnancy / lactation considerations1
Anesthetic-context use only; no specific monograph restriction.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 124–126 (atracurium), p. 933–935 (pancuronium), p. 1046–1047 (rocuronium) — Pregnancy & Lactation · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Sources: Plumb DC. Plumb's Veterinary Drug Handbook. 7th ed. PharmaVet Inc; 2011.
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