DOSES OF NEUROMUSCULAR BLOCKERS NEED TO BE CAREFULLY TITRATED FOR INDIVIDUAL PATIENTS ACCORDING TO RESPONSE, AND MAY VARY WITH THE PROCEDURE, THE OTHER DRUGS GIVEN, AND THE STATE OF THE PATIENT; MONITORING OF THE DEGREE OF BLOCK IS RECOMMENDED IN ORDER TO REDUCE THE RISK OF OVERDOSAGE. THE USUAL INITIAL DOSE FOR INTUBATION IS 80 TO 100 MICROGRAMS/KG BY INTRAVENOUS INJECTION, ALTHOUGH REDUCED INITIAL DOSES OF 30 TO 50 MICROGRAMS/KG ARE SUGGESTED FOLLOWING THE USE OF SUXAMETHONIUM. HIGHER INITIAL DOSES RANGING FROM 150 TO 300 MICROGRAMS/KG HAVE SOMETIMES BEEN USED FOR OTHER PROCEDURES. HOWEVER, IT IS RECOMMENDED THAT THE DOSE SHOULD NOT EXCEED 100 MICROGRAMS/KG IN CAESAREAN SECTION OR NEONATAL SURGERY. MAINTENANCE DOSES OF 20 TO 30 MICROGRAMS/KG MAY BE GIVEN AS REQUIRED DURING PROLONGED PROCEDURES; IN THE USA A LOWER MAINTENANCE DOSE OF 10 TO 15 MICROGRAMS/KG IS RECOMMENDED. NEUROMUSCULAR BLOCKADE MAY ALSO BE MAINTAINED WITH AN INTRAVENOUS INFUSION GIVEN AT A RATE OF 0.8 TO 1.4 MICROGRAMS/KG PER MINUTE BUT SHOULD BE PRECEDED BY AN INITIAL BOLUS INJECTION OF 40 TO 100 MICROGRAMS/KG. UK LICENSED PRODUCT INFORMATION RECOMMENDS THAT IN OBESE PATIENTS THE DOSAGE OF VECURONIUM SHOULD BE REDUCED TAKING INTO ACCOUNT LEAN BODY-MASS.
CHILDREN OLDER THAN 5 MONTHS CAN BE GIVEN ADULT DOSES BUT CHILDREN UP TO 1 YEAR MAY HAVE A MORE RAPID RESPONSE AND THE HIGH INITIAL DOSE FOR INTUBATION MAY NOT BE NECESSARY. NEONATES AND INFANTS BELOW 5 MONTHS OF AGE MAY BE MORE SENSITIVE TO VECURONIUM AND IT IS RECOMMENDED THAT THEY SHOULD BE GIVEN AN INITIAL TEST DOSE OF 10 TO 20 MICROGRAMS/KG, FOLLOWED BY INCREMENTS ACCORDING TO RESPONSE. THE DURATION OF ACTION AND RECOVERY IS LONGER IN NEONATES AND INFANTS THAN IN CHILDREN AND ADULTS AND THEY MAY REQUIRE SMALLER MAINTENANCE DOSES GIVEN LESS FREQUENTLY.