Nondepolarizing Agents — Comparison
Duration, elimination, cardiovascular effects, and sugammadex eligibility
| Agent |
Duration |
Elimination |
Cardiovascular Effect |
Sugammadex |
| Pancuronium |
Long |
Renal |
Vagolytic — tachycardia |
No |
| Vecuronium |
Intermediate |
Hepatic |
None |
Yes |
| Rocuronium |
Intermediate |
Biliary |
None |
Yes |
| Atracurium |
Intermediate |
Hofmann elimination |
Histamine release (high dose) |
No |
| Cisatracurium |
Intermediate |
Hofmann elimination |
None |
No |
| Mivacurium |
Short |
Plasma cholinesterase |
Histamine release (high dose) |
No |
- Inhibits acetylcholinesterase → more acetylcholine at receptor
- Requires atropine or glycopyrrolate to block muscarinic effects
- Cannot reverse deep block (ceiling effect)
- Works for all nondepolarizing agents
- Encapsulates rocuronium and vecuronium in plasma
- No antimuscarinic needed — no muscarinic side effects
- Reverses deep block reliably
- Does not work for benzylisoquinolinium agents