Atrium

Atracurium besilate

Adjunct to general anesth during surgery to relax skeletal muscles & to facilitate endotracheal intubation & mechanical ventilation. Facilitate mechanical ventilation in ICU patients.

Initial bolus doses for intubation Initially 0.3-0.6 mg/kg (depending on the duration of full block required) IV bolus inj & will provide adequate relaxation for about 15-35 min. Endotracheal intubation 0.5-0.6 mg/kg IV inj accomplished w/in 90-120 sec. Maintenance of neuromuscular blockade during prolonged surgical procedures Intermittent IV inj 0.1-0.2 mg/kg. Infusion 0.3-0.6 mg/kg/kg continuous IV infusion. Should not be commenced until early spontaneous recovery from the initial atracurium bolus dose is evident. Facilitation of mechanical ventilation in ICU patient After an optional initial bolus dose of 0.3-0.6 mg/kg, neuromuscular block may be maintained by continuous infusion at rates between 11 & 13 mcg/kg/min (0.65 to 0.78 mg/kg/hr). Infusion rates as low as 4.5 mcg/kg/min (0.27 mg/kg/hr) or as high as 29.5 mcg/kg/min (1.77 mg/kg/hr) are required in some patients. Patient w/ CV disease Administer initial dose over a period of at least 60 sec.

Hypersensitivity.

Do not give by IM inj. Anaphylactic reactions to curares. History suggestive of an increased sensitivity to the effects of histamine. Should not be mixed w/ alkaline soln (eg, barbiturate soln) in the same syringe or administered simultaneously during IV infusion through the same needle. Flush vein w/ an adequate vol of physiological saline. Patients w/ myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of non-depolarizing agents has been noted; severe electrolyte disorders. Bradycardia. Resistance may develop in patients suffering from burns. Patients unusually sensitive to fall in arterial BP eg, hypovolemic patients. Not be administered into the infusion line of blood transfusion. Monitor serial creatine phosphokinase values in asthmatic patients receiving high dose corticosteroids & neuromuscular blocking agents in ICU. May affect ability to drive or operate machinery. Pregnancy & lactation. Not recommended in neonates.

Tachycardia, bradycardia; inj site reaction; wheezing; localized skin reactions, rash, itching; HTN, hypotension, vasodilatation (flushing).

Increased the magnitude &/or duration of effects w/ isoflurane, desflurane, sevoflurane, enflurane anesth (potentiated); halothane anesth (marginally potentiated); aminoglycosides, polymyxins, spectinomycins, tetracyclines, lincomycin, clindamycin, vancomycin; phenytoin, carbamazepine; local anesth eg, lidocaine, procainamide, quinidine; propranolol, oxprenolol; chloroquine, d-penicillamine; diltiazem, nicardipine, nifedipine, verapamil; furosemide, thiazides, acetazolamide, mannitol; trimetaphan, hexamethonium; dantrolene, parenteral Mg sulphate, chlorpromazine, steroids, ketamine, lithium salts, quinine. Prolonged & complex block (difficult to reverse w/ anticholinesterase drugs) w/ a depolarizing muscle relaxant eg, suxamethonium Cl. Antagonized neuromuscular blockade & increased risk &/or severity of myopathy resulting in prolonged flaccid paralysis w/ IV corticosteroids. Lengthened onset & shortened duration of neuromuscular blockade w/ chronic anticonvulsant therapy (eg, carbamazepine, phenytoin).

Neuromuscular Blocking Agents

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

Rx