Indications & Dose: ENDOTRACHEAL INTUBATION IV Adult 0.06-0.1mg/kg upto 0.16mg/kg. Additional doses of 0.01mg/kg administered at an interval of 25-60min to maintain skeletal muscle relaxation during prolonged surgery | GENERAL ANAESTHESIA Adjunct therapy IV Adult 0.04-0.1mg/kg Child > 1 month: 0.04-0.1mg/kg | NEUROMUSCULAR BLOCKADE DURING SURGERY Long-term therapy IV Child Neonate: Initially 100µg/kg followed by 50µg/kg repeat if needed, 1 month–18 yr: Initially 100µg/kg followed by 20µg/kg repeat if needed

Precautions: Renal/hepatic impairment, history of anaphylactic reactions, patients with raised catecholamine levels, elderly/debilitated patients, history of asthma, pulmonary impairment/respiratory depression, patients with myasthenia gravis, electrolyte abnormalities, hypothermia

ADR: Serious: Elevation in pulse rate, cardiac output & BP, tachycardia, circulatory collapse, edema, hypersensitivity reaction, bronchospasm, Others: profound muscle weakness, excessive salivation, skin flushing, rash, itching, erythema, burning sensation, wheezing

DDI: Serious Cimetidine/Ciclosporin/Clindamycin/Diltiazem/Nifedipine/Salbutamol/Vecuronium/Verapamil enhances neuromuscular blockade activity, Local anesthetics/GA increases & prolongs neuromuscular blockade, Aminoglycosides increases & prolongs neuromuscular blockade & leads to fatal respiratory depression, Phenytoin increases drug clearance, Digoxin leads to serious cardiac arrhythmias, Azathioprine/Antilymphocyte immunoglobulins reduces neuromuscular blockade activity

Monitor: HR, BP, assisted ventilation status