Atracurium

Atracurium - is a non-depolarising neuromuscular blocker that is broken down by Hofmann degradation and ester hydrolysis.The ampoules have to be stored in the fridge to prevent spontaneous degradation.Atracurium has an elimination half-life of 20 min. The principal metabolite is laudanosine, which can cause convulsions in dogs. Even with long-term infusions, the concentration of laudanosine is well below the seizure threshold (17ug/ml). It is the agent of choice in renal and hepatic failure.

Uses:
Muscle paralysis
Contraindications
Airway obstruction
To facilitate tracheal intubation in patients at risk of regurgitation

Administration:
• IV bolus: 0.5 mg/kg, repeat with 0.15 mg/kg at 20–45 min interval
• IV infusion: 0.2–0.4 mg/kg/h
Monitor with peripheral nerve stimulator

How not to use atracurium:
As part of a rapid sequence induction
In the conscious patient
By persons not trained to intubate trachea

Adverse effects:
Bradycardia
Hypotension

Cautions:
Asthmatics (histamine release)
Breathing circuit (disconnection)
Prolonged use (disuse muscle atrophy)

Organ failure:
Hepatic: increased concentration of laudanosine
Renal: increased concentration of laudanosine