The recommended initial dose of Vecuronium is 0.08 to 0.10 mg/kg body weight given as an I.V. bolus injection. This dose can be expected to produce good or excellent non-emergency intubation conditions in 2.5 to 3.0 minutes after injection. In caesarean section and neonatal surgery the dose should not exceed 0.1 mg/kg. Like other neuromuscular blocking agents, Vecuronium Bromide should only be administered by, or under supervision of, experienced clinicians who are familiar with the action and use of these agents; the dosage of Vecuronium Bromide should be individualized in each patient. Consequently, adjustments with Vecuronium Bromide should be made by administering smaller maintenance doses at less frequent intervals or by using lower infusion rates of Vecuronium Bromide during long lasting procedures (longer than 1 hour) under inhalational anaesthesia. In adult patients the following dosage recommendations may serve as a general guideline for tracheal intubation and muscle relaxation for short to long lasting surgical procedures. Tracheal intubation: The standard intubating dose during routine anaesthesia is 0.08 to 0.1 mg Vecuronium Bromide per kg body weight, after which adequate intubation conditions are established within 90 to 120 seconds in nearly all patients. Dosages of Vecuronium Bromide for surgical: procedures after intubation with suxamethonium: If suxamethonium is used for intubation, the administration of Vecuronium should be delayed until the patient has clinically recovered from the neuromuscular block induced by suxamethonium. Recommended dose is 0.03 to 0.05 mg Vecuronium Bromide per kg body weight. Maintenance dosing: The recommended maintenance dose is 0.02 to 0.03 mg Vecuronium Bromide per kg body weight. These maintenance doses should best be given when twitch height has recovered to 25% of control twitch height. Dose requirements for administration of Vecuronium Bromide by continuous infusion: If Vecuronium is administered by continuous infusion, it is recommended to give a loading dose (0.08 to 0.1 mg Vecuronium Bromide per kg body weight) first and, when neuromuscular block starts to recover, to start administration of Vecuronium by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to train of four stimulation. In adults, the infusion rate required to maintain neuromuscular block at this level, ranges from 0.8 to 1.4 µg Vecuronium Bromide/kg/min. Repeat monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anaesthetic method used. Dosing in elderly patients: The same intubation and maintenance doses as for younger adults (0.08-0.1 mg/kg and 0.02-0.03 mg/kg, respectively) can be used. The onset time in elderly is similar to younger adults. Dosing in paediatric patients: Neonate (up to 4 weeks) and children up to 4 months: initial test dose 0.01 to 0.02 mg/kg then incremental doses until 90% to 95% depression of twitch response is achieved is recommended. In neonatal surgery the dose should not exceed 0.1 mg/kg. Children over 5 months to 10 years: 0.08-0.1 mg/kg (children under 12 months, onset more rapid and high intubation dose may not be required); maintenance 0.02-0.03 mg/kg adjusted according to response. Since the duration of action is shorter in children, maintenance doses are required more frequently. Dosing in overweight and obese patients: When used in overweight or obese patients doses should be reduced taking into account an ideal body weight. Initial doses ranging from 0.15 mg up to 0.30 mg Vecuronium Bromide per kg body weight have been administered during surgery both under halothane and neurolept anaesthesia.
