RELOCURIUM
ATRACURIUM BESYLATE · by BAJWA
Composition
Inj: Per ml: Atracurium besylate 10 mg.
Indications & Dosage
Neuromuscular blockade (short to intermediate duration) for surgery and wide range of procedures, to facilitate controlled ventilation and endotracheal intubation: BY IV INJ: Adult: Initially 300-600 mcg/kg, then (by IV injection) 100-200 mcg/kg as required, This dosage provides relaxation for 15-35 min. Full block can be prolonged with supplementary doses of 0.1-0.2 mg/kg as required. Endotracheal intubation can usually be accomplished within 90 sec from the IV inj of 0.5-0.6 mg/kg. As an INF: After an initial bolus dose of 0.3-0.6 mg/kg neuromuscular block can be maintained by administration as a continuous INF at rates of 0.3-0.6, mg/kg/hr. Children Neonate: initially by IV injection 300-500 mcg/kg followed either by IV injection, 100-200 mcg/kg repeated as necessary or by IV INF, 300-400 mcg/kg/hr adjusted according to response 1 month-18 yr: Initially by IV injection 300-600 mcg/kg then 100-200 mcg /kg repeated as necessary or initially by IV injection 300-600 mcg/kg followed by IV INF, 300-600 mcg/kg/hr adjusted according to response. Neuromuscular blockade during intensive care: BY IV INJ: Adult: Initially 300-600 mc/kg, initial dose is optional, then (by intravenous INF) 270-1770 mc/kg/hour; (by intravenous INF) usual dose 650-780 mcg/kg/hour. Children Neonate: initially by IV injection 300-500 mcg/kg followed either by IV injection, 100-200 mcg /kg repeated as necessary or by IV INF, 300-400 mcg/kg/hr adjusted according to response; higher doses may be necessary; 1 month-18 yr: Initially by IV injection 300-600 mcg/kg (optional) then by IV INF, 270-1770 mcg/kg/hr (usual dose 650-780 mcg/kg/ hr).
Administration
Should be administered only with adequate general anaesthesia and under the close supervision of an experienced anaesthetist and with adequate facilities for endotracheal intubation and artificial ventilation. May be administered undiluted as a bolus injection, administration via infusion requires the use of an infu-sion pump. Use infusion solutions within 24 hours of preparation.
Compatibility
Stable in D5W, NS, D5NS; incompatible with LR. At Y-site administration, incompatible with diazepam, propofol, thiopental
Stability
Refrigerate; unstable in alkaline solution.
Contraindications
Atracurium besylate hypersensitivity.
Precautions
Burns (increased doses may be required), cardiovascular disease (reduce rate of administration), electrolyte and fluid disturbances, hypothermia, myasthenia gravis, neuromuscular disorders. To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.
Interactions
Anticholinesterases, thiazide diuretics.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Anaphylactoid reactions (rare), acute myopathy (after prolonged use in intensive care), bronchospasm, hypotension, seizures, skin flushing, tachycardia, cardiovascular effects