Higher infusion rates may be required and duration of action may be shortened in patients receiving long-term carbamazepine or phenytoin.
IV (Adults and Children) >2 yr) 0.4–0.5 mg/kg initially (0.25–0.35 mg/kg if administered after steady-state anesthesia with enflurane or isoflurane or 0.3–0.4 mg/kg following succinylcholine); may then repeat with 0.08–0.1 mg/kg 20–45 min after initial dose as needed, or by continuous infusion at 5–9 mcg/kg/min.
IV (Neonates, Infants, and Children 1 mo–2 yr) 0.3–0.4 mg/kg initially followed by maintenance doses of 0.3–0.4 mg/kg as needed.
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Solution for injection: 10 mg/mL
Assess respiratory status continuously throughout therapy with atracurium. Use only to facilitate intubation or in patients already intubated.
Monitor neuromuscular response with a peripheral nerve stimulator intraoperatively. Paralysis is initially selective and usually occurs sequentially in the following muscles: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, intercostal muscles, and the diaphragm. Recovery of muscle function usually occurs in reverse order.
Monitor ECG, heart rate, and BP throughout administration.
Observe the patient for residual muscle weakness and respiratory distress during the recovery period.
Monitor infusion site frequently. If signs of tissue irritation or extravasation occur, discontinue and restart in another vein.
Toxicity Overdose: If overdose occurs, use peripheral nerve stimulator to determine the degree of neuromuscular blockade. Maintain airway patency and ventilation until recovery of normal respirations occurs.
Administration of anticholinesterase agents (neostigmine, pyridostigmine) may be used to antagonize the action of atracurium once the patient has demonstrated some spontaneous recovery from neuromuscular block. Atropine is usually administered prior to or concurrently with anticholinesterase agents to counteract the muscarinic effects.
Administration of fluids and vasopressors may be necessary to treat severe hypotension or shock.
High Alert: Unplanned administration of a neuromuscular blocking agent instead of administration of the intended medication or administration of a neuromuscular blocking agent in the absence of ventilatory support has resulted in serious harm and death. Confusing similarities in packaging and insufficiently controlled access to these medications are often implicated in these medication errors.
Dose is titrated to patient response.
Atracurium has no effect on consciousness or pain threshold. Adequate anesthesia/analgesia should always be used when neuromuscular blocking agents are used as an adjunct to surgical procedures or when painful procedures are performed. Benzodiazepines and/or analgesics should be administered concurrently when prolonged neuromuscular blocker therapy is used for ventilator patients, because patient is awake and able to feel all sensations.
If eyes remain open throughout prolonged administration, protect corneas with artificial tears.
Store atracurium in refrigerator.
Most neuromuscular blocking agents are incompatible with barbiturates and sodium bicarbonate. Do not admix.
IV Push: May be administered undiluted.
Rate:Administer initial IV dose as a bolus over 1 min.
Intermittent Infusion: Maintenance dose is usually required 20–45 min following initial dose.
Diluent: D5W, 0.9% NaCl, or D5/0.9% NaCl.Administer every 15–25 min or by continuous infusion.
Continuous Infusion: Maintenance dose is administered by infusion. Concentration: 0.5 mg/mL for continuous infusion.
Rate:Titrate according to patient response.
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Explain all procedures to patient receiving atracurium therapy without general anesthesia, because consciousness is not affected by atracurium alone.
Reassure patient that communication abilities will return as the medication wears off.
Adequate suppression of the twitch response when tested with peripheral nerve stimulation and subsequent muscle paralysis.
Improved compliance during mechanical ventilation.
atracurium is a sample topic from the Davis's Drug Guide.
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