Relaston

Indications

Atracurium besylate is a muscle relaxant used in hospitals 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 acetylcholine, the chemical that carries the signal from nerves to muscles, at the point where they meet (the neuromuscular junction). Without this signal the muscles relax temporarily. It does not cause sleep or relieve pain, so it is always given with anaesthetic and pain medicines. It breaks down in the blood on its own, so it is useful in liver or kidney failure.

Dosage and Administration

Given only by an anaesthetist or trained doctor in an operating theatre or intensive care unit, as an injection or infusion into a vein. The dose is based on body weight and adjusted by monitoring muscle response. Breathing is always supported by a machine while it acts.

Interactions

• Inhaled anaesthetics, some antibiotics (such as Gentamicin and other aminoglycosides, Clindamycin), Magnesium, Lithium, some antiarrhythmics and diuretics can strengthen or prolong its effect.
• Long-term use of Phenytoin or Carbamazepine may reduce its effect.
• Its effect is reversed with Neostigmine given with Atropine or Glycopyrrolate.

Contraindications

• Known allergy to atracurium or Cisatracurium.
• It must not be used where breathing cannot be supported.

Side Effects

It can release histamine, causing skin flushing, a short fall in blood pressure or a faster heartbeat. Rarely it causes wheezing (bronchospasm) or severe allergic reactions. Long use in intensive care may be linked to muscle weakness.

These effects are watched for and treated immediately by the anaesthetic team. After the operation, tell the staff at once if you have difficulty breathing, swallowing or moving, or feel very weak.

Pregnancy and Lactation

It can be used during pregnancy and Caesarean section when the anaesthetist judges it appropriate; very little crosses the placenta. Breastfeeding can usually resume once the mother is awake and recovered from anaesthesia; ask the medical team.

Precautions and Warnings

• Use with care in myasthenia gravis and other nerve or muscle diseases, asthma or a history of allergy, burns, and severe salt or acid imbalance.
• Tell the anaesthetist about any previous reactions to anaesthesia.

Overdose

Overdose causes prolonged muscle paralysis and inability to breathe. The team continues breathing support and gives reversal medicines 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. Protect from light. Hospital use: keep and handle as directed on the pack.