Indications
Atracurium Besilate is a muscle relaxant used during general anaesthesia. It relaxes the muscles so that a breathing tube can be placed in the windpipe, makes surgery easier, and helps patients on a breathing machine (ventilator) in intensive care.
How It Works
Atracurium blocks the signal between nerves and muscles by occupying the receptors that normally respond to the nerve chemical acetylcholine. As a result, the muscles, including the breathing muscles, become relaxed and cannot contract. It does not cause sleep or relieve pain, so it is always given with anaesthetic and pain medicines. It breaks down in the blood by itself, so its action does not depend much on the liver or kidneys.
Dosage and Administration
Atracurium is given only by an anaesthetist or trained doctor in a hospital or operating theatre with full breathing support available. It is given into a vein as a single injection or as a continuous infusion, with the dose worked out from the patient’s body weight and response. Muscle function is monitored throughout, and breathing is supported until the effect wears off or is reversed.
Interactions
The effect can be made stronger or longer by inhaled anaesthetics, aminoglycoside antibiotics such as Gentamicin, Polymyxins, Clindamycin, Magnesium Sulfate, Lithium, some heart medicines such as Verapamil and Quinidine, and diuretics that lower potassium. Long-term use of Phenytoin or Carbamazepine may reduce its effect. Neostigmine is used to reverse it at the end of surgery.
Contraindications
Do not use in people allergic to Atracurium, Cisatracurium or other similar muscle relaxants.
Side Effects
It can release histamine, causing skin flushing, rash, a fall in blood pressure, fast heartbeat or wheezing, especially with rapid or large doses. Rarely, serious allergic reactions (anaphylaxis) occur. Muscle weakness may last longer than expected, especially after long use in intensive care. Seizures have been reported very rarely in intensive care patients after prolonged infusion.
The patient is watched closely by the medical team. After surgery, tell staff straight away about difficulty breathing or swallowing, unusual weakness, rash or swelling.
Pregnancy and Lactation
Atracurium can be used in pregnancy, including for Caesarean section, when the anaesthetist judges it necessary, as only small amounts cross the placenta. It is unlikely to affect a breastfed baby once the mother has recovered from anaesthesia; follow the advice of the medical team.
Precautions and Warnings
- Must be used only where staff and equipment for airway management and ventilation are available.
- Extra care in myasthenia gravis and other nerve or muscle diseases, severe burns, electrolyte imbalance, asthma or a history of allergy.
- It does not cause unconsciousness; adequate anaesthesia must be given to prevent awareness.
Overdose
Overdose causes prolonged paralysis and inability to breathe. Treatment is continued breathing support with a ventilator and sedation until muscle function returns, plus reversal with Neostigmine given with Atropine or Glycopyrronium when appropriate.
Therapeutic Class
Non-depolarising neuromuscular blocking agent (skeletal muscle relaxant)
Storage
Store in a refrigerator at 2 to 8°C, do not freeze, and protect from light, or as directed on the pack. Hospital use only; keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.