Pancuronium vagolytic effect — FRCA Primary MCQ

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HardPharmacologyPancuronium vagolytic effectFRCA Primary

A patient undergoing prolonged abdominal surgery develops sinus bradycardia during high vagal stimulation. The anaesthetist avoids one long-acting neuromuscular blocker because it may cause tachycardia. Which drug has this vagolytic tendency?

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Correct answer: D — Pancuronium

Pancuronium can cause tachycardia through vagolytic and sympathomimetic effects. Rocuronium is a tempting answer because it is an aminosteroid, but it has much less vagolytic effect than pancuronium. Atracurium and mivacurium are more associated with histamine release, while cisatracurium has minimal histamine release. Autonomic side effects can matter as much as duration when choosing a relaxant.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care