GasGasGas - Anaesthetic Science for Anaesthesia! Pancuronium and NMJ block terminology
Mar 20, 2026
A deep dive into pancuronium’s origins, chemistry and clinical properties. Clear explanations of its mechanism, dosing, duration and autonomic effects. A focused primer on neuromuscular block terminology, contrasting Type 1 and Type 2 blocks and their clinical implications. Practical notes on toxicity, side effects and pharmacokinetics.
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Pancuronium Mechanism Onset And Duration
- Pancuronium is a competitive non-depolarizing antagonist at post-synaptic nicotinic N2 receptors and also affects presynaptic modulation, contributing to fade.
- Onset for intubation is ~2.5 minutes at 0.1 mg/kg with peak effect ~4 minutes and very long duration (~90+ minutes).
Cardiovascular Effects From Pancuronium
- Pancuronium has ganglionic and vagolytic activity, producing tachycardia, raised blood pressure and increased cardiac output.
- It rarely causes histamine release, so bronchospasm is uncommon compared with some other agents.
Avoid Premature Reversal With Long Acting Blockers
- Avoid premature reversal when long-acting blockers like pancuronium have been used because neostigmine may wear off while pancuronium persists, risking re-curarization.
- Remember recovery from long-acting agents is prolonged and reversal timing must consider drug half-life.