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Pregnancy and breastfeeding |
Pregnancy
Like all other curare, atracurium should be avoided during the first quarter and should only be used during the second and the third quarters in case of absolute necessity.
Breastfeeding
Atracurium does not pass in mother’s milk. It can be used for anesthesia in breastfeeding women. It is, however, recommended to suspend breastfeeding during 24 hours after atracurium administration. |
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Drugs interactions |
Certain substances can modify the intensity and/or the duration of non depolarizing curare effects.
Drugs susceptible to major non depolarizing curare effects are:
- Halogen volatile anesthetics such as isoflurane, enflurane, desflurane, sevoflurane and halothane.
- Local anesthetics
- Certain antibiotics (aminosides, polymyxines, lincosamides, tetracyclines)
- Magnesium sulfate (I.V)
- Calcium channels blockers
- dantrolene
- Drugs which can reveal or worsen a myasthenia, or even produce a myasthenia syndrome such as quinidine, lithium, propanolol, injectable corticoids and telithromycine.
Drugs susceptible to diminish non depolarizing curare effects are:
- phenytoine and carbamazepine chronically administered
- Suxamethonium, administered in aim to prolong the non depolarizing curare effect, can provoke a complex block which is hard to antagonize with anti-cholinesterase agents.
- Theoretically, a monitoring maintained until complete decurarization can permit to manage all the interactions. However, a non expected recurarization can occur in case of post-operative antibiotic administration with an aminoside, for example.
Drugs requiring precautions of use:
- Aminnosides, colistine, lincosanides, polymyxine B: potentialization of curare when antibiotics are administered by parenteral or peritoneal route before, during or after the curare. The curarization level should be monitored at the end of anesthesia.
Drugs to be taken into account:
Glucocorticoids I.V administration (except hydrocortisone for substitutive therapy): risk of severe myopathy, which can be reversible after a long time (several months). |
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Undesirable effects |
Like all active product, atracurium can provoke in some patients some undesirable effects:
- Severe allergic reactions
- Cutaneous redness and eruptions
- Blood pressure lowering
- Exceptional brochospasm
- And even, an anaphylactic reaction
- Convulsions seizures: exceptionally and in case of prolonged use in reanimation in renal insufficient patients
- After a prolonged use of myorelaxing agents in patients in intensive care units, cases of muscular weakness or myopathy were reported. |
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Dosage and mode of administration |
Dosage
The dosage of atracurium depends on the patient’s body weight, the intensity, the mode and the duration of intended curarization. The dosage should be adjusted according to the neuro-muscular monitoring.
Use in anesthesia:
Adults and children over than three months:
- Intravenous injection:
• A dose of 0.6mg/kg gives good intubation conditions in, generally, 2 minutes.
• 0.3 – 0.6mg/kg (according to the aimed curarization duration) induce a deep curarization of 15 – 35 minutes.
- Continuing infusion:
During prolonged surgical interventions, and after an initial bolus of 0.3 – 0.6mg/kg, atracurium, at the dose of 0.3 – 0.6mg/kg/h in continuing infusion, maintains an adequate neuro-muscular block.
Children less than three months:
- The doses of 0.3 – 0.6mg/kg in I.V injection or 0.3 – 0.6mg/kg/h in infusion, induce a longer curarization than in adults. It is recommended to adapt the dosage and to take into the account the large individual variability of response to curare in this age interval. The use of infusion requires a neuro-muscular monitoring.
- Under one month it is careful to reduce the dosage.
Use in reanimation
After an initial bolus of 0.3 – 0.6mg/kg, atracurium maintain an adequate neuro-muscular block in continuing infusion at the dose of 0.65 – 0.78mg/kg/h.
Mode of administration:
- Atracurium 25mg is administered by intravenous route in single injection or in continuing infusion.
- Atracurium should be not mixed in the same syringe to thiopental or to any other alkaline solution. |
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