Atracurium Besylate

Indications

Atracurium Besylate is used for: General anaesthesia, Endotracheal intubation, Aid controlled ventilation

Adult Dose

Intravenous Muscle relaxant in general anaesthesia, Endotracheal intubation, Aid controlled ventilation Adult: Initially, 300-600 mcg/kg as inj. Subsequently, 100-200 mcg/kg when necessary or every 15-25 minutes for maintenance in prolonged procedures. Alternatively, maintenance can also be achieved by continuous infusion at 5-10 mcg/kg/minute. Initial dose should be given over 60 seconds in patients with CV disease. Dose should be calculated based on ideal body-weight in obese patients. Special Populations: For patients with significant CV disease or any history (e.g. severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release, an initial dose of 0.3-0.4 mg/kg should be given slowly or in divided doses over 1 min. For adults receiving atracurium following the use of succinylcholine for intubation under balanced anesthesia, an initial dose of 0.3-0.4 mg/kg is recommended. Dosage reductions may be necessary in patients with neuromuscular disease, severe electrolyte disorders or carcinomatosis in which potentiation of neuromuscular block or difficulties with reversal have been demonstrated.

Child Dose

Intravenous Muscle relaxant in general anaesthesia, Endotracheal intubation, Aid controlled ventilation Child: >2 mth: Initially, 400-500 mcg/kg as inj. Maintenance dose: 80-100 mcg/kg; first maintenance dose may be given 20-45 min after the initial dose, subsequently, may be repeated every 15-25 min. For children 1 mth-2 yr: 300-400 mcg/kg may be used as initial dose in those who are under halothane anaesthesia. Maintenance doses may be admin more frequently in infant and children than adults.

Renal Dose

Administration

Contra Indications

Hypersensitivity.

Precautions

Neonates; severe CVS disorders; renal or hepatic dysfunction; myasthenia gravis and other neuromuscular disorders; severe electrolyte imbalances; respiratory insufficiency or pulmonary disease, asthma; burns; cardiopulmonary bypass; smoking; pregnancy and lactation. Dosage for obese patients should be based on ideal body-weight to prevent overdosing.

Pregnancy-Lactation

Pregnancy Category: C Lactation: excretion in milk unknown; use with caution

Interactions

Mixed block with suxamethonium which is difficult to reverse with anticholinergic drugs. Ketamine may potentiate the effects of atracurium. Concurrent use with tamoxifen or danazol may prolong effects of atracurium. Potentially Fatal: Neuromuscular blockade potentiated by parenteral Mg salts, anaesthetics, aminoglycosides and polypeptide antibiotics, botulinum A toxin. Malignant hyperthermia with halogenated anaesthetics and succinylcholine. MAOIs.

Adverse Effects

Side effects of Atracurium Besylate : Cutaneous reactions; bradycardia, transient hypotension in patients with CVS disorders; dyspnoea, bronchospasm; rash and urticaria.

Mechanism of Action

Atracurium besilate blocks neural transmission at the neuromuscular junction by competitive binding at the cholinergic receptor sites on the motor end plate.