IV Injection: Adults:
Recommended Dose: 0.3-0.6 mg/kg (depending on the duration of full block required) and will provide adequate relaxation for about 15-35 min.
Endotracheal intubation can usually be accomplished within 90 sec from IV injection of 0.5-0.6 mg/kg.
Full block can be prolonged with supplementary doses of 0.1-0.2 mg/kg as required. Successive supplementary dosing does not give rise to accumulation of neuromuscular-blocking effect.
Spontaneous recovery from the end of full block occurs in about 35 min as measured by the restoration of the tetanic response to 95% of normal neuromuscular function.
The neuromuscular block produced by atracurium can be rapidly reversed by standard doses of anticholinesterase agents eg, neostigmine and edrophonium, accompanied or preceded by atropine, with no evidence of recurarisation.IV Infusion:
After an initial IV bolus dose of 0.3-0.6 mg/kg, atracurium can be used to maintain neuromuscular block during long surgical procedures by administration of continuous infusion at rates of 0.3-0.6 mg/kg/hr.
Atracurium can be administered by infusion during cardiopulmonary bypass surgery at the recommended infusion rates. Induced hypothermia to a body temperature of 25-26°C reduces the rate of inactivation of atracurium, therefore, full neuromuscular block may be maintained by approximately half the original infusion rate at these low temperatures.
Atracurium is compatible with the following infusion for the times stated as follows:Click on icon to see table/diagram/image
When diluted in these solutions to give atracurium besylate concentrations of ≥0.5 mg/mL, the resultant solutions will be stable in daylight for the stated periods at temperatures of up to 30°C.Patients with Reduced Renal and/or Hepatic Function:
Atracurium may be used at standard dosage at all levels of renal or hepatic function, including end-stage failure.Patients with Cardiovascular Disease:
In patients with clinically significant cardiovascular disease, the initial dose of atracurium should be administered over a period of 60 sec.ICU Patients:
After an optional initial bolus dose of atracurium of 0.3-0.6 mg/kg, atracurium can be used to maintain neuromuscular block by administering a continuous infusion at rates of 11 and 13 mcg/kg/min (0.65-0.78 mg/kg/hr). There may be wide interpatient variability in dosage requirements and these may increase or decrease with time. Infusion rates as low as 4.5 mcg/kg/min (0.27 mg/kg/hr) or as high as 29.5 mcg/kg/min (1.77 mg/kg/hr) are required in some patients.
The rate of spontaneous recovery from neuromuscular block after infusion of atracurium in ICU patients is dependent on the duration of administration.Children:
The dosage in children >1 month is similar to that in adults on body weight basis.Elderly:
Atracurium may be used at standard dosage.
It is recommended, however, that the initial dose be at the lower end of the range and administered slowly.
Monitoring: Common to all neuromuscular-blocking agents, monitoring of neuromuscular function is recommended during the use of atracurium in order to individualise dosage requirements.