Pancuronium (Pavulon)

Class: Nondepolarizing neuromuscular blocker/ paralytic

Indications: Induction or maintenance of paralysis after intubation to assist ventilations

Contraindications: Hypersensitivity, inability to control airway and support ventilations with O2 and positive pressure, neuromuscular disease, hepatic or renal failure.

Dose: Adult and peds 0.1mg/kg slow IV repeat every 30-60 min

Mechanism of Action: Binds to the receptor for acetycholine at the neuromuscular junction

Side Effects: Apnea, weakness, salivation, premature ventricular contractions, tachycardia, transient hypotension, increased blood pressure, pain and burning at injection site

How Supplied: 4mg/2mL ampule

Duration of Action: Onset-30 sec, Peak-paralysis 3-5 min, Duration-45-60 min

Special Considerations: Sedate pt before using, intubation and ventilatory support readily available, has no effect on consciousness or pain, pulse rate and cardiac output increased

Midazolam (Versed)

Class: Short acting benzodiazepine CNS depressant

Indications: Sedation, anxiolytic prior to ET or nasotracheal intubation, admin for conscious sedation

Contraindications: Glaucoma, shock, coma, alcohol intoxication, OD, depressed vitals, cocomitant use with other CNS depressants, barbituates, alcohol, narcotics

Dose: Adult: 2.0-2.5mg slow IV over 2-3min max 0.1mg/kg Peds: not recommended

Mechanism of Action: Anxiolytic and sedative properties similar to other benzodiazepines

Side Effects: Hiccough, cough, oversedation, nausea, vomiting, injection site pain, headache, blurred vision, hypotension, respiratory depression and arrest

Supplied: 2, 5, 10mL vials (1mg/mL), 1, 2, 5, 10mL vials (5mg/mL)

Duration of Action: Onset: 1-3 min (IV dose dependent), Peak: variable,  Duration: 2-6hr (dose dep)

Special Considerations: Pregnancy D, administer immediately prior to intubation, continuous monitor respiratory and cardiac, never administer as IV bolus

Vecuronium (Norcuron)

Class: Paralytic agent

Indications: To facillitate intubation, terminate laryngospasms, promote muscle relaxation, facilitate electroconvulsive shock therapy

Contraindications: Acute narrow angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations w/O2 and positive pressure, newborns, hepatic or renal failure

Dose: Adult: 0.1mg/kg IV push, maint dose within 25-40 min (0.01-0.05 mg/kg)  peds (20-35 min)

Mechanism of Action: Nondepolarizing neuromuscular blocking agent, paralytic

Side Effects: Apnea, waekness, salivation, premature ventricular contractions, tachycardia, transient hypotension, increased blood pressure

Supplied: 10mg/10mL vecuronium bromide vials with dilutent 20mL (20mg vecuronium) w/o dilutant

Duration of Action: Onset 30sec,Peak 2.5-3 min,Dur25-35 min

Special Considerations: Pregnancy C, closely monitor vitals, be prepared to resuscitate, AV block or asystole may occour as aresult of slowed AV conduction 

Succinylcholine (anectine)

Class: depolarizing neuromuscular blocker, Paralyzing agent

Indications: to facilitate intubation, terminate laryngospasms, promote muscle relaxation, facilitate electroconvulsive shock therapy

Contraindications: Acute narrow angle glaucoma, penetrating eye injuries inability to control airway or support ventilations with O2 and positive pressure

Dose: Adult: 1-2mg/kg rapid IV, Peds: 1-1.5mg/kg rapid IV/IO (both may repeat once if needed)

Mechanism of Action: Bind to receptors of acetycholine

Side Effects: Apnea, malignant hyperthermia, arrhythmias, bradycardia, hypotension, cardiac arrest, hyperkalemia, increased intraocular pressure, fasciculations

Supplied: 40mg/2mL ampule (20mg/mL) 100mg/5mL ampule (20mg/mL) multidose vial

Duration of Action: Onset 1 min, Peak 1-3 min, Duration 5 min

Special considerations: Pregnancy C, EMS use primarily to facilitate ET intubation, premedication with lidocaine may blunt any increase in intracranial pressure

Fentanyl Citrate (Sublimaze)

Class: Narcotic analgesic

Indications: Pain

Contraindications: Hypersensitivity, respiratory depression, caution with traumatic brain injury

Dose: Adult 50-100 mcg IM or slow IV/IO (1-2 min) Peds 1-2 mcg/kg IM or slow IV/IO (1-2 min)

Mechanism of Action: Binds to opiate receptors producing analgesia and euphoria

Side Effects: Respiratory depression, apnea, hypo-hypertension, nausea/vomiting, dizziness, sedation, euphoria, sinus bradycardia, sinus tachycardia, palpitations, diaphoresis, syncope

Supplied:  100mcg/2mL ampule

Duration of Action: Onste: immediate, Peak 3-5 min, Duration 30-60 min

Special Considerations: Protect from sunlight, monitor vitals, have O2 available, resuscitative and intubation equipment and an opioid antagonist (narcan)  ready