Tracrium

Atracurium besylate

As an adjunct to general anaesth to enable tracheal intubation, to relax skeletal muscles during surgery or controlled ventilation & to facilitate mechanical ventilation in ICU patient.

Adult IV inj 0.3-0.6 mg/kg. Supplementary doses: 0.1-0.2 mg/kg as required. Infusion Maintenance of neuromuscular block during long surgical procedures After initial bolus of 0.3-0.6 mg/kg, continuous infusion at rates 0.3-0.6 mg/kg/hr. Childn >1 mth Adult dose on a body wt basis. Elderly Initial dose should be at the lower end of the range & administered slowly. Renal & hepatic impairment Standard dosage. Patients w/ CV disease Administer initial dose over a period of 60 sec. ICU patients Initial bolus 0.3-0.6 mg/kg. Maintain neuromuscular block Continuous infusion at rates 11-13 mcg/kg/min.

Hypersensitivity to atracurium, cisatracurium or benzenesulfonic acid.

History of increased sensitivity to effects of histamine & hypersensitivity to neuromuscular blockers. Consider monitoring serial creatinine phosphate in asthmatic patients. Myasthenia gravis & other neuromuscular disease; hypophosphataemia. Patients unusually sensitive to falls in arterial BP eg, hypovolaemic. Must not be mixed in the same syringe as thiopentone or any alkaline agent. Not to be administered into the infusion line of a blood transfusion. Burn patients. Lactation.

Mild & transient hypotension, skin flushing. Bronchospasm.

Increased neuromuscular block w/ inhalational anaesth eg, halothane, isoflurane & enflurane; antibiotics including aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin & clindamycin; anti-arrhythmic drugs (propranolol, Ca-channel blockers, lidocaine, procainamide & quinidine); diuretics (furosemide & possibly mannitol, thiazide diuretics & acetazolamide); Mg sulphate; ketamine; lithium salts; ganglion blocking agents (trimetaphan, hexamethonium). May aggravate or unmask latent myasthenia gravis or actually induce a myasthenic syndrome w/ various antibiotics, β-blockers (propranolol, oxprenolol), anti-arrhythmic drugs (procainamide, quinidine), antirheumatic drugs (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroids, phenytoin & lithium. Lengthened onset of nondepolarising neuromuscular block & shortened duration of block w/ chronic anticonvulsant therapy. Prolonged & complex block w/ depolarising muscle relaxant eg, suxamethonium Cl. Shortened duration & diminished magnitude of neuromuscular blockade w/ anticholinesterases eg, donepezil.

Neuromuscular Blocking Agents

M03AC04 - atracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

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