vecuronium and RSI

Q: Why Vecuronium is not recommended as an alternative to succinylcholine for Rapid Sequence Intubation (RSI) despite its good hemodynamic profile?


Answer: Vecuronium is not recommended as an alternative to succinylcholine for RSI due to its slower onset time of three to four minutes. The clinical duration of action is 25 to 50 minutes. Also, it is excreted both through the biliary and renal routes, and patients with renal or hepatic dysfunction may have a prolonged response to vecuronium. 

 If vecuronium is used for intubation, it requires a priming dose of 0.01 mg/kg at least three minutes prior to an intubating dose of 0.15 mg/kg.

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Reference:

Baumgarten RK, Carter CE, Reynolds WJ, et al. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth 1988; 35:5.