Atracurium

Indications

  • Need for Procedural/Operative Paralysis
  • Need for Sedation to Facilitate Mechanical Ventilation in Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])
  • Rapid Sequence Intubation (RSI) (see Airway Management, [[Airway Management]])

Pharmacology

Metabolism

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-Metabolism: non-enzymatic Hoffman rxn + ester hydrolysis in plasma (does not depend on renal or hepatic metabolism)
– Burn patients may show resistance to NMJ blockers


Administration

  • Load (IV): 0.4-0.5 mg/kg

    • Onset of Action: 110 sec
    • Duration of Action: 43 min
  • Maintenance (IV): 4-20 µg/kg/min

Dose Adjustment

  • Hepatic:
  • Renal:

Drug Interactions

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-Drug Interactions (all enhance Atra effect): lithium, aminoglycosides, polymyxins, magnesium, quinidine, procainamide


Adverse Effects

*Absence of Vagolytic Effect
*May Cause Histamine Release -> Bronchospasm/Hypotension

-SE: histamine release (hypotension, wheezing)/minimal ganglionic block/prolonged NMJ block (rare)
– No reports of vagal block tachycardia

Other Adverse Effects

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References

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