Question about Vecuronium

loisane · Jun 15, 2004

I remember this being a big problem when Norcuron went off patent, and we started using generic vecuronium. My department's collective opinion was that there was a real difference in predictability between the brand and the generic.

Don't know if this is still the feeling there, that facility has changed formulary to all rocuronium now.

And I don't know if this has ever been formally documented anywhere.

loisane crna

jwk · Jun 15, 2004

I remember this being a big problem when Norcuron went off patent, and we started using generic vecuronium. My department's collective opinion was that there was a real difference in predictability between the brand and the generic.
Don't know if this is still the feeling there, that facility has changed formulary to all rocuronium now.
And I don't know if this has ever been formally documented anywhere.
loisane crna

I think you're correct, there does seem to be more variability with the generic vec.

If it wasn't significantly more expensive, we'd probably use even more roc than we currently do. Anything longer than 3 hrs or so, we tend to lean towards vec because of the cost savings. A few of our anesthetists are using cis-atracurium, but I've never been thrilled with it personally.

versatile_kat · Jun 16, 2004

gonnabe ... not on the subject but are you at UNC Charlotte?

NeuroICURN · Jun 16, 2004

Ok-let me preface this by saying I am a first year SRNA. . . I have a question regarding potency of vecuronium. When doing a long case and you have used more than one bottle of vec has anyone had issues with what seemed to be different levels of potency between bottles?? I have had at least one case (maybe two) where pt would remain flat/or 1 twitch with same amount over same period of time-got a new bottle and just didn't seem to be working same way (no changes to any other settings-gas, etc. etc.) Mixed a new bottle and voila-was back in business. Just wondering if anyone else has experienced this- I looked online for any other discussions regarding this and couldn't find anything-maybe I am crazy, but the CRNA I was with suggested she had seen that before. Anyone????

Yup...I've noticed that too...never gave it much thought until you brought it up here. Thought maybe I was going crazy! :chuckle Then again, maybe I am! LOL

Qwiigley, BSN, MSN, DNP, RN, CRNA · Jun 16, 2004

Found this by accident in practice. Directions for Vec are to mix with sterile water, I use whatever in the drawer. If you use NS, doesn't last as long.

FYI

gonnabe · Jun 16, 2004

Thanks Quiigley,

I have to think that may have been the case with at least my last experience. We often pre-mix and have ready to go in drawer-so sometimes may have been drawn up by somebody else and they used NS-I often use myself figuring it really didn't make much difference. Guess it does-thanks for the enlightenment!!!!! Maybe I'll be able to predict my timing a little better :)

NeuroICURN · Jun 16, 2004

Found this by accident in practice. Directions for Vec are to mix with sterile water, I use whatever in the drawer. If you use NS, doesn't last as long.
FYI

Well, that couldn't explain my experiences...I ALWAYS mix with sterile water.

HawaiiRN · Jun 16, 2004

I thought mixing with sterile water (vs NS) just has an effect on the solubility, making the vec powder mix quickly- not the half life of the drug- because don't you inject into a line that generally has NS infusing through it??

Athlein1 · Jun 16, 2004

JWK,

Why don't you like cis-atracurium? I just started using it and really like it. Am I just getting lucky or have you had a negative experience with it?

RN_PICU · Nov 5, 2011

I would stop doing that, and strictly stick to the instructions!!!! I know its much easier to grab a syringe with 10cc of NS and squirt it down, but if anything goes wrong for what ever reason I would not like to be in a position of explaining why was NS saline used and not sterile water!!!!

allnurses Guide · Nov 5, 2011

It doesn't matter if it is NS or Sterile Water. This is extremely old thread, and those were probably the initial instructions a long time ago.

The differences that you will see with repeated dosing in the same patient is usually d/t context sensitive half lives.

"Infusion solutions of vecuronium can be prepared by mixing vecuronium with an appropriate infusion solution such as Dextrose Injection 5%, Sodium Chloride Injection 0.9%, Dextrose (5%) and Sodium Chloride Injection, or Lactated Ringer's Injection."

http://www.globalrph.com/vecuronium_dilution.htm