29 September 2025 : Review article
Age-Specific Pharmacology of Neuromuscular Blocking Agents: A Comprehensive Review
Paweł Radkowski
ABCDEFG 1,2,3, Kacper Kowalczyk ABCDEF 4, Anna Łęczycka ABCDEF 4, Hubert Oniszczuk BDE 5*, Łukasz Grabarczyk DEFG 6
DOI: 10.12659/MSM.949656
Med Sci Monit 2025; 31:e949656
Table 2 NMBAs in elderly – summary.
| NMBA | Recommended dose | Key considerations |
|---|---|---|
| Succinylcholine | 1 mg/kg | Fast onset time makes it favorable. However, prolonged duration of action necessitates caution |
| Atracurium | 0.5 mg/kg | Due to decreased clearance, the duration of action and consequent recovery can be prolonged. There is are insufficient studies regarding different dosages in the elderly |
| Cisatracurium | 0.1–0.15 mg/kg | Onset time might be extended. Consistent duration time and low patient variability in older patients makes it a predictable option |
| Mivacurium | 0.15–0.25 mg/kg | Prolonged duration of action and time to spontaneous recovery should be considered when used |
| Pancuronium | 0.1 mg/kg initial dose or 0.7–2 μg/kg/min continuous infusion | Duration of action and spontaneous recovery may be prolonged. Monitoring should be implemented |
| Vecuronium | 0.1 mg/kg | An increase in the duration of action and consequent recovery has been noted |
| Rocuronium | 0.6–1.0 mg/kg | Duration of action and spontaneous recovery may be prolonged. Different studies show discrepancies in the onset time, with some predicting shorter and some longer durations. Hence, neuromuscular monitoring should be utilized |
| Neostigmine | 0.04–0.05 mg/kg (with atropine 0.02 mg/kg) | Duration of action is prolonged. Reversal is highly variable in individuals, making it unpredictable. At higher doses it may result in adverse effects like bradycardia, convulsions, slurred speech, nausea, vomiting, and anxiety |
| Sugammadex | 2.0–8.0 mg/kg | Preferred reversal method of neuromuscular block in the elderly. However, the recovery is prolonged |