• Pipecuronium is a muscle relaxant. It is used as an adjunct to general anesthesia to allow skeletal muscle relaxation during the surgery.
Pipecuronium is a long-acting neuromuscular blocking agent which causes reversible paralysis of the skeletal muscles. It is used to provide skeletal muscle relaxation during surgery.
It is also recommended to provide relaxation of skeletal muscles during endotracheal intubation (procedure involves placing a tube into the windpipe to maintain an open airway).
It works by blocking the signal transmission at the junction connecting muscles and nerves.
• Due to the long duration of action of pipecuronium, it is not advised to use it in myasthenia gravis or Eaton-Lambert syndrome, a long-term neuromuscular disorder that causes skeletal muscle weakness.
• Pipecuronium should not be used either before or after other non-depolarizing neuromuscular blocking agents or in patients requiring long-term mechanical ventilation in the intensive care unit (ICU).
• It is also not advised to use it in cases of cesarean sections due to the risk of transfer of the drug through the placenta to the fetus. Also, the effect of the drug lasts for longer than the duration of the cesarean section.
The dose is calculated according to the age, sex, body weight or degree of obesity, kidney function, liver disease and other existing diseases in the patient.
• Adult Dose:
The usual adult dose range is 50 - 100 mcg/kg.
• Endotracheal intubation under balanced anesthesia:
For patients with normal kidney function and not obese, the recommended initial dose is 70 - 85mcg/kg which offers approximately 1 to 2 hours of clinical relaxation.
• Recovery from succinylcholine used for endotracheal intubation:
A dose of 50mcg/kg is injected which provides relaxation of approximately 45 minutes. It should not be used before succinylcholine.
• Maintenance dose:
A dose of 10 - 15mcg/kg under balanced anesthesia provides approximately 50 minutes of relaxation.
• Child Dose under balanced and inhalational anesthesia:
Infants 3 months to 1 year: 40mcg/kg dose of relaxation of 10 to 44 minutes
Children 1 year to 14 years of age: 57mcg/kg dose for a relaxation of 18 to 52 minutes
Pipecuronium should not be used in neonates and infants below 3 months of age.
• Pipecuronium comes as a powder for injection as 10mg single dose vial and should be administered intravenously under the supervision of an expert.
• It is recommended for surgeries that last longer than one and a half an hour because of the long-acting effect of pipecuronium.
• Severe allergic reactions are reported with pipecuronium. So immediate access to adequate emergency treatment should be available.
• Intensive monitoring of vital organ function is needed during the paralysis and post-operative recovery.
• Pipecuronium should be used with caution in patients with kidney or liver disease.
• Cardiovascular: Decreased blood pressure, decreased heart rate, chestpain, abnormal heart rhythm and thrombosis (formation of a clot in a blood vessel).
• Central Nervous System: Decreased brain activity, reduced sensation of touch
• Respiratory: Difficulty in breathing, respiratory depression, laryngeal muscle spasm, and lung collapse
• Metabolic: Decreased blood sugar level, increased blood potassium level and creatinine level
• Others: Anuria (passage of less or no urine), skin rashes, a decrease in the muscle mass and an allergic reaction including an anaphylactic reaction.
• Pipecuronium has no effect on consciousness and pain, therefore it should be always accompanied by anesthesia.
• In case of overdosage, neostigmine is used to reverse the effects of pipecuronium.
• A peripheral nerve stimulator can be used to identify the nature and degree of the neuromuscular blockade.
• Since pipecuronium contains bromide, it should be avoided inpatients who had episodes of bromide allergy.
• Antibiotics such as aminoglycoside antibiotics (amikacin, tobramycin, streptomycin), tetracycline and vancomycin, as well as verapamil may increase the neuromuscular blocking effects of pipecuronium.
• Quinidine may increase the risk of recurrent paralysis when administered with pipecuronium. • Inhalational anesthetics like enflurane, isoflurane and halothane may increase the duration of neuromuscular block.
• Magnesium salts may increase the effect of pipecuronium when used for toxemia in pregnancy.
• The therapeutic efficacy of pipecuronium may be decreased by tacrine, pyridostigmine, rivastigmine, and decamethonium.
• Stored between 2°−30°C and should be protected from light.
• It should not be kept in a freezer.
• After reconstitution with sterile water for injection, the vial should be refrigerated and must be used within 24 hours. The unused portion beyond this period must be discarded.
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