Indications
Atracurium is indicated for endotracheal intubation, facilitate mechanical ventilation in intensive care, muscle relaxant in general anaesthesia.
Pharmacology
Atracurium antagonizes the neurotransmitter action of acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate. This antagonism is inhibited, and neuromuscular block reversed, by acetylcholinesterase inhibitors such as neostigmine, edrophonium, and pyridostigmine.
Dosage And Administration
Adult and Child (>1 month): Initially, 300-600 mcg/kg as bolus IV, with subsequent doses of 100-200 mcg/kg by IV every 15-25 min or 5-10 mcg/kg/min by infusion in prolonged procedures. Higher infusion rate may be used in patients undergoing controlled ventilation in intensive care.
Interaction
Enhanced neuromuscular blocking effect w/ general anaesth (e.g. enflurane, isoflurane, halothane), certain antibiotics (e.g. aminoglycosides, polymyxins), lithium, Mg salts, procainamide, quinidine.
Contraindications
Atracurium is contraindicated in patients known to be hypersensitive to atracurium, cisatracurium or benzenesulfonic acid. In common with all the other neuromuscular blocking agents, atracurium besilate paralyses the respiratory muscles as well as other skeletal muscles but has no effect on consciousness.
Side Effects
Skin flush, erythema, pruritus, urticaria, wheezing, increased bronchial secretions, bronchospasm, cyanosis, angioedema, CV effects (e.g. bradycardia); wheals and erythema at inj site. Potentially Fatal: Anaphylaxis.
Pregnancy And Lactation
Pregnancy Category C: Teratogenic Effects. Atracurium besylate has been shown to be potentially teratogenic in rabbits when given in doses up to approximately one-half the human dose. There are no adequate and well-controlled studies in pregnant women. Atracurium should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Precautions And Warnings
Patient with CV disease, burn injury, asthma; conditions which may antagonise neuromuscular blockade (e.g. resp alkalosis, hypercalcaemia, demyelinating lesions, peripheral neuropathies, denervation, muscle trauma); conditions which may potentiate neuromuscular blockade (e.g. electrolyte abnormalities, neuromuscular diseases, metabolic acidosis, resp acidosis, Eaton-Lambert syndrome, myasthenia gravis). Pregnancy and lactation.
Overdose Effects
Stimulation of histamine release, CV effects especiall hypotension
Therapeutic Class
Non depolarizing muscle relaxants
Storage Conditions
Store between 2-8° C. Do not freeze.