Shortage of injectable pancuronium

The American Society of Health-System Pharmacists reports a shortage of pancuronium for injection. This drug shortage impacts surgery and intubation. In both procedures it is used to temporarily paralyze the skeletal muscles. This is an instance in which changing to one of the alternatives can cause confusion and errors because medical personnel may not be familiar with the different time of onset, duration of effect (see table), and the agent used to reverse the effects. For example, pancuronium's effects are routinely reversed with neostigmine, but if you use succinylcholine to paralyze the skeletal muscles, neostigmine increases the effect.

Injectable pancuronium is the second drug administered for lethal injection, and Hospira is now the only US-approved manufacturer. This further complicates the implementation of death warrants because of the shortage of injectable pentobarbital, the first drug administered for lethal injection. Links to my previous posts are given below.

Shortage of injectable pentobarbital for execution by lethal injection 

Shortage of injectable pentobarbital for execution by lethal injection - Update