Section 1 - CHEMICAL PRODUCT AND COMPANY IDENTIFICATION

PRODUCT NAME

PANCURONIUM BROMIDE

NFPA

PRODUCT USE

Used as a muscle relaxant. Of the class of so- called non- depolarising agents (also known
as competitive neuromuscular blocking agents) it interrupts neuromuscular transmission by
competing with acetylcholine for receptor sites on the motor end- plate. When given by
injection produces paralysis of voluntary muscles. Used as an adjuvant to anaesthesia to
obtain greater muscle relaxation.

SYNONYMS

C35-H60-Br2-N2-O4, "piperidinium, 1, 1'-(2beta, 16beta-(3alpha, 17beta-dihydroxy-5alpha-
androstanylene)bis(1-methyl-, dibromide, diacetate", "5alpha-androstan-3alpha, 17beta-
diol, 2beta, 16beta-dipicolinio dibromide diacetate", "1, 1'-(3, 17-
bis(acetyloxy)androstane-2, 16-diyl)", "1, 1'-(3, 17-bis(acetyloxy)androstane-2, 16-
diyl)", "bis(1-methylpiperidinium) dibromide", "3alpha, 17-beat-diacetoxy-2-beta, 16-beta-
dipiperidino-5-alpha-androstanedimethobromide", "3alpha, 17-beat-diacetoxy-2-beta, 16-
beta-dipiperidino-5-alpha-androstanedimethobromide", "poncuronium bromide", Mioblock,
"Org NA-97", Pavulon, "muscle relaxant/", "non-depolarising agent"

Section 2 - HAZARDS IDENTIFICATION

CANADIAN WHMIS SYMBOLS

EMERGENCY OVERVIEW

RISK

POTENTIAL HEALTH EFFECTS

ACUTE HEALTH EFFECTS

SWALLOWED

  Accidental ingestion of the material may be damaging to the health of the individual.  Tubocurarine and its structural analogues rarely produces side-effects at levels employed during anaesthesia but in overdose may cause respiratory failure (by paralysing intercostal muscles and the diaphragm) and hypotension. Regurgitation of stomach contents may also occur as a result of relaxation of the oesophageal muscle and sphincters. May cause bronchospasm due to histamine release. Members of this family of muscle relaxant have relatively little cardiovascular activity although tachycardia has been reported.  Bromide poisoning causes intense vomiting so the dose is often removed. Effects include drowsiness, irritability, inco-ordination, vertigo, confusion, mania, hallucinations and coma. Other effects include skin rash, nervous system symptoms, sensory disturbances and increased spinal fluid pressure. They have been used as sedatives and depress the central nervous system. Toxicity is increased if dietary chloride is reduced. Repeated ingestion can cause a syndrome with acne, confusion, irritability, tremor, memory loss, weight loss,  headache, slurred speech, delusions, stupor, psychosis and coma.  

EYE

  Although the material is not thought to be an irritant, direct contact with the eye may cause transient discomfort characterized by tearing or conjunctival redness (as with windburn). Slight abrasive damage may also result. The material may produce foreign body irritation in certain individuals.  

SKIN

  Skin contact with the material may damage the health of the individual; systemic effects may result following absorption.  The material is not thought to be a skin irritant (as classified using animal models). Abrasive damage however, may result from prolonged exposures. Good hygiene practice requires that exposure be kept to a minimum and that suitable gloves be used in an occupational setting.  Entry into the blood-stream, through, for example, cuts, abrasions or lesions, may produce systemic injury with harmful effects. Examine the skin prior to the use of the material and ensure that any external damage is suitably protected.  

INHALED

  Inhalation may produce health damage*.  Inhalation of dusts, generated by the material during the course of normal handling, may be damaging to the health of the individual.  The material is not thought to produce respiratory irritation (as classified using animal models). Nevertheless inhalation of dusts, or fume, especially for prolonged periods, may produce respiratory discomfort and occasionally, distress.  

CHRONIC HEALTH EFFECTS

  Long term exposure to high dust concentrations may cause changes in lung function i.e. pneumoconiosis; caused by particles less than 0.5 micron penetrating and remaining in the lung. Prime symptom is breathlessness; lung shadows show on X-ray.  Limited evidence suggests that repeated or long-term occupational exposure may produce cumulative health effects involving organs or biochemical systems.  There is limited evidence that, skin contact with this product is more likely to cause a sensitization reaction in some persons compared to the general population.  There is some evidence that human exposure to the material may result in developmental toxicity. This evidence is based on animal studies where effects have been observed in the absence of marked maternal toxicity, or at around the same dose levels as other toxic effects but which are not secondary non-specific consequences of the other toxic effects.  Exposure to small quantities may induce hypersensitivity reactions characterized by acute bronchospasm, hives (urticaria), deep dermal wheals (angioneurotic edema), running nose (rhinitis) and blurred vision . Anaphylactic shock and skin rash (non-thrombocytopenic purpura) may occur. An individual may be predisposed to such anti-body mediated reaction if other chemical agents have caused prior sensitization (cross-sensitivity).  Chronic intoxication with ionic bromides, historically, has resulted from medical use of bromides but not from environmental or occupational exposure; depression, hallucinosis, and schizophreniform psychosis can be seen in the absence of other signs of intoxication. Bromides may also induce sedation, irritability, agitation, delirium, memory loss, confusion, disorientation, forgetfulness (aphasias), dysarthria, weakness, fatigue, vertigo, stupor, coma, decreased appetite, nausea and vomiting, diarrhoea, hallucinations,  an acne like rash on the face, legs and trunk, known as bronchoderma (seen in 25-30% of case involving bromide ion), and a profuse discharge from the nostrils (coryza). Ataxia and generalised hyperreflexia have also been observed. Correlation of neurologic symptoms with blood levels of bromide is inexact. The use of substances such as brompheniramine, as antihistamines, largely reflect current day usage of bromides; ionic bromides have been largely withdrawn from therapeutic use due to their toxicity. Several cases of foetal abnormalities have been described in mothers who took large doses of bromides during pregnancy.