Atracurium Besylate

Atracurium Besylate is a highly selective, competitive (non-depolarizing) neuromuscular blocking agent used as an adjunct to general anesthesia to enable tracheal intubation and relax skeletal muscles during surgery or controlled ventilation.

Atracurium blocks neural transmission at the neuromuscular junction by competitive binding at cholinergic receptor sites on the motor end plate. It is inactivated in plasma via two nonoxidative pathways: ester hydrolysis and Hofmann elimination, a nonenzymatic process occurring at physiological pH and temperature.

Common side effects include flushing, skin rash, itching, and injection site reactions. The duration of neuromuscular block does not correlate with plasma pseudocholinesterase levels and is not altered by the absence of renal function.

• Skeletal muscle relaxation during general anesthesia
• Facilitation of endotracheal intubation
• Controlled ventilation during surgical procedures
• Facilitation of mechanical ventilation in ICU patients

Atracurium Besylate is a highly selective, competitive (non-depolarizing) neuromuscular blocking agent used as an adjunct to general anesthesia. It blocks neural transmission at the neuromuscular junction by competitive binding at cholinergic receptor sites on the motor end plate.

Atracurium is inactivated in plasma via two nonoxidative pathways: ester hydrolysis, catalyzed by nonspecific esterases; and Hofmann elimination, a nonenzymatic chemical process which occurs at physiological pH and temperature. The liver and kidneys do not play a major role in its elimination.

Atracurium blocks neural transmission at the neuromuscular junction by competitively binding to cholinergic receptor sites on the motor end plate, preventing acetylcholine from binding and generating an endplate potential.

The duration of neuromuscular block produced by atracurium does not correlate with plasma pseudocholinesterase levels and is not altered by the absence of renal function.

Adult Dosage:

• Initial bolus: 0.3-0.6 mg/kg (depending on duration of full block required); intubation can usually be accomplished within 90 seconds at 0.5-0.6 mg/kg
• Maintenance dose: 0.1-0.2 mg/kg as required
• Continuous infusion: 0.3-0.6 mg/kg/hour during long surgical procedures
• Cardiovascular disease patients: 0.3-0.4 mg/kg, administered slowly over 60 seconds
• Long-term ICU infusion: Average 11-13 mcg/kg/min (range: 4.5-29.5)

Pediatric (>1 month): Same dosage as adults

Elderly: Standard dosage can be used, but starting at the lower end of the range is recommended

Other: Continuous monitoring of neuromuscular function is recommended during long-term ICU use. Dosage for obese patients should be based on ideal body weight.

For intravenous use only. Do not administer intramuscularly. Should not be mixed with alkaline solutions (e.g., barbiturate solutions).

Atracurium is administered only by trained healthcare professionals in hospital settings. The concept of a missed dose is not applicable.

Very Common (≥1/10):

• Skin flushing

Common (≥1/100 to <1/10):

• Skin rash, itching
• Hypotension (mild, transient)
• Injection site reactions (pain, swelling, redness)

Uncommon/Rare:

• Anaphylactic/anaphylactoid reactions (including shock, circulatory failure)
• Prolonged muscle paralysis (in overdose)

ICU patients (rare):

• Seizures (in patients with predisposing conditions)
• Muscle weakness and myopathy (after prolonged administration, often with corticosteroids)

Serious Precautions:

• Atracurium should be used only by those skilled in airway management and respiratory support.
• Severe anaphylactic reactions have been reported; immediate availability of emergency treatment is required.
• Extreme caution in patients with myasthenia gravis or other neuromuscular diseases.
• Caution in patients with severe electrolyte disorders, respiratory insufficiency, or asthma.
• Continuous monitoring of neuromuscular transmission is recommended during long-term ICU use.

• Hypersensitivity to atracurium, cisatracurium, or benzenesulfonic acid
• Patients in whom substantial histamine release would be especially hazardous (e.g., significant cardiovascular disease)

• Succinylcholine: Prior use decreases time to maximum block by approximately 2-3 minutes and may increase depth of block
• Inhalational anesthetics (isoflurane, enflurane): May potentiate neuromuscular block; dose reduction may be needed
• Other non-depolarizing blockers: Additive effects may occur

[CONSULT YOUR DOCTOR] Atracurium is administered under general anesthesia; alcohol consumption is not relevant. Standard precautions for driving and operating machinery after general anesthesia apply.

[CONSULT YOUR DOCTOR] Limited data on atracurium use during pregnancy (Category C). Animal studies have shown no significant effects on fetal development. Does not cross the placenta in clinically significant amounts at recommended doses, and can be used during cesarean section. Use only if potential benefit justifies the risk.

[CONSULT YOUR DOCTOR] It is not known whether atracurium is excreted in human milk. Use with caution in nursing mothers.

Children over 1 month of age: Same dosage as adults. Neuromuscular function monitoring is recommended in pediatric patients.

Standard dosage can be used in elderly patients, but starting at the lower end of the range is recommended.

Renal Impairment: Standard dosage is safe at all levels of renal function.

Hepatic Impairment: Standard dosage is safe at all levels of hepatic function.

Symptoms: Prolonged muscle paralysis.

Management: Maintain patient airway and provide assisted positive pressure ventilation until spontaneous respiration is adequate. Full sedation is required since consciousness is not impaired. Once signs of spontaneous recovery appear, recovery may be accelerated by administration of cholinesterase inhibitors with atropine or glycopyrrolate.

Vial (unreconstituted): Store in a refrigerator at 2-8°C. Do not freeze.

Reconstituted/diluted solution: Can be stored at 2-8°C for up to 24 hours.

Keep out of reach of children. Protect from light.

Atracurium Besylate