Atracurium
Mechanism :
Atracurium is a nondepolarizing skeletal muscle relaxant. Nondepolarizing agents antagonize the neurotransmitter action of acetylcholine by binding competitively with cholinergic receptor sites on the motor end-plate.
Indication :
- As an adjunct to general anaesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Contraindications :
Atracurium is contraindicated in patients known to have a hypersensitivity to it and in neonates. Its advantage is that, it does not require any dosage adjustment in renal or hepatic disease as it spontaneously degrades in the plasma.
Dosing :
1 month to 2 years: 0.3-0.4 mg/kg IV initially followed by maintenance dose of 0.3-0.4 mg/kg as and when needed to maintain neuromuscular blockade.
>2 years (same as adults): 0.4-0.5 mg/kg IV over 1 min, followed by 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block. Repeat maintenance doses every 15-25 mins as and when required.
Adverse Effect :
Flushing, erythema, itching, wheezing, bronchial secretions, pruritus, urticaria and hives.
Interaction :
Enflurane; Isoflurane; Halothane; Certain Antibiotics, especially the Aminoglycosides and Polymyxins; Lithium; Magnesium Salts; Procainamide; and Quinidine: Enhance actions of atracurium.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.