Summary In many respects, pipecuronium is similar to pancuronium. Its neuromuscular blocking potency is equal to or slightly greater than that of pancuronium and, consequently, its routine use in clinical practice should follow the existing general pattern for pancuronium. A dose of 0.05 mg/kg following intubation with suxamethonium will provide adequate muscle relaxation for 40–50 minutes. For intubation, however, the dose should be increased to 0.08–0.1 mg/kg which will give satisfactory intubating conditions in 2.5–3 minutes and adequate surgical relaxation for 80–120 minutes. As with pancuronium, cumulative effects after repeated doses and potentiation of inhalation anaesthetic agents—particularly by enflurane—can be expected. Therefore, maintenance doses should be one-quarter of the initial dose or less, and should be administered at 40–50-minute or 60–70-minute intervals following the use of low (0.05 mg/kg) or high (0.1 mg/kg) initial doses, respectively. When using potent inhalation anaesthetics, the size of maintenance doses should be decreased further (one-fifth to one-sixth of the initial dose) or the time interval between them prolonged. Pipecuronium appears to be free from histamine-releasing properties. The most important advantage of this compound in comparison with other long-acting drugs like pancuronium or alcuronium is that it is devoid of circulatory effects. These properties, if confirmed in widespread clinical use, will make pipecuronium the drug of choice for long operations, particularly in patients with cardiovascular disease. It should not, however, by used in patients with renal or hepatic disease until more information on its pharmacokinetics in such patients becomes available. The availability of pipecuronium bromide will not remain limited to eastern European countries for long. Recently, Gedeon Richter Ltd (Hungary) licensed Organon Teknika (Belgium) to manufacture and market pipecuronium in western Europe, the USA and in a number of other countries. The ampoules currently used contain 4 mg of the freeze-dried agent that should be dissolved in 2 ml solvent. Arduan should be stored in the refrigerator at 4°C and should be used shortly after dissolving the powder.