Dr Mark Moore MD
Tallahassee's Anesthesiologist



Atracurium: is used as an adjunct to general anesthesia to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Atracurium is one of several intermediate-acting nondepolarizing NeuroMuscular Blocking Drugs (NMBDs). Nondepolarizing intermediate-acting NMBDs function by competing with Acetylcholine in binding to postjunctional nicotinic cholinergic receptors on the motor end plate and prevent changes in ion permeability. Ion permeability is responsible for propagation of action potentials in neurons and is important in cell function as well. Thus atracurium and other non-depolarizing NMBDs prevent depolarization of "message" receptors and effectively prevents the propagation of the message to the muscles. This causes temporary skeletal muscle paralysis. Atracurium begins acting approximately 3 to 5 minutes after administration and has a duration of about 20 to 35 minutes at an effective dose (ED) of approximately 0.2 mg/kg which is effective for ~95% of patients (ED95). Possible side effects of the drug may include heart rate irregularities and/or a decrease in blood pressure at relatively large doses.

The benefit of Atracurium over other NMBDs is that it has two routes of metabolism (how the body deals with the drug). Significantly, however, these routes are independent of liver and kidney function as well as blood plasma cholinesterase activity. Thus, the effectiveness of Atracurium is similar in normal patients and those with hepatic problems, kidney dysfunction, or atypical plasma cholinesterase. For this reason, atracurium may be preferentially selected for use with persons with renal or hepatic medical histories.

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