No

Neuromuscular Blocker Agent, Nondepolarizing

Drug of choice for neuromuscular blockade in patients with renal and/or hepatic failure; eases endotracheal intubation as an adjunct to general anesthesia and relaxes skeletal muscle during surgery or mechanical ventilation; does not relieve pain

C

Hypersensitivity to atracurium besylate or any component

Reduce initial dosage in patients in whom substantial histamine release would be potentially hazardous (eg, patients with clinically important cardiovascular disease); maintenance of an adequate airway and respiratory support is critical

Mild, rare, and generally suggestive of histamine release

<1%: Cardiovascular effects are minimal and transient, erythema, itching, urticaria, wheezing, bronchial secretions

Causes of prolonged neuromuscular blockade:

Excessive drug administration

Cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal impairment)

Accumulation of active metabolites

Electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia, hypernatremia)

Hypothermia

Drug interactions

Increased sensitivity to muscle relaxants (eg, neuromuscular disorders such as myasthenia gravis or polymyositis)

Symptoms of overdose include respiratory depression, cardiovascular collapse

Neostigmine 1-3 mg slow I.V. push in adults (0.5 mg in children) antagonizes the neuromuscular blockade, and should be administered with or immediately after atropine 1-1.5 mg I.V. push (adults). This may be especially useful in the presence of bradycardia.

Prolonged neuromuscular blockade:

Halothane has only a marginal effect, enflurane and isoflurane increases the potency and prolong duration of neuromuscular blockade induced by atracurium by 35% to 50%

Dosage should be reduced by 33% in patients receiving isoflurane or enflurane and by 20% in patients receiving halothane

Local anesthetics

Calcium channel blockers

Corticosteroids

Antiarrhythmics (eg, quinidine or procainamide)

Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin)

Immunosuppressants (eg, cyclosporine)

Refrigerate; unstable in alkaline solutions; compatible with D₅W, D₅NS, and NS; do not dilute in LR

Blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites

Onset of action: I.V.: 2 minutes

Peak effect: Within 3-5 minutes

Duration: Recovery begins in 20-35 minutes when anesthesia is balanced

Metabolism: Some metabolites are active; undergoes rapid nonenzymatic degradation in the bloodstream, additional metabolism occurs via ester hydrolysis

Half-life, biphasic: Adults: Initial: 2 minutes; Terminal: 20 minutes

I.V. (not to be used I.M.):

Children >2 years to Adults: 0.4-0.5 mg/kg, then 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block

Infusions (require use of an infusion pump): 0.2 mg/mL or 0.5 mg/mL in D₅W or NS

Continuous infusion: Initial: 9-10 mcg/kg/minute followed by 5-9 mcg/kg/minute maintenance

Dosage adjustment for hepatic or renal impairment is not necessary

May be given without further dilution by rapid I.V. injection; for continuous infusions, dilute to a maximum concentration of 0.5 mg/mL (more concentrated solutions when diluted with I.V. fluids have reduced stability, ie, <24 hours at room temperature)

Vital signs (heart rate, blood pressure, respiratory rate)

None reported

None reported

May be difficult to talk because of head and neck muscle blockade

Not for I.M. injection due to tissue irritation

Injection, as besylate: 10 mg/mL (5 mL, 10 mL)

Injection, preservative-free, as besylate: 10 mg/mL (5 mL)

Peat SJ, Potter DR, and Hunter JM, "The Prolonged Use of Atracurium in a Patient With Tetanus," Anaesthesia, 1988, 43(11):962-3.

Yate PM, Flynn PJ, Arnold RW, et al, "Clinical Experience and Plasma Laudanosine Concentrations During the Infusion of Atracurium in the Intensive Therapy Unit," Br J Anaesth, 1987, 59(2):211-7.