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Atracurium (Atracurium Besylate) - Summary




Atracurium Besylate Injection is an intermediate-duration, nondepolarizing, skeletal muscle relaxant for intravenous administration. Atracurium besylate is designated as 2,2’-[1,5-pentanediylbis[oxy (3-oxo-3,1-propanediyl)]]bis[1-[(3,4 dimethoxyphenyl)methyl]- 1,2,3,4-tetrahydro-6,7-dimethoxy-2-methylisoquinolinium]dibenzenesulfonate.

Atracurium Besylate Injection is indicated, as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

See all Atracurium indications & dosage >>


Media Articles Related to Atracurium

New clue to how anesthesia works
Source: Pain / Anesthetics News From Medical News Today [2014.11.18]
Anesthesia, long considered a blessing to patients and surgeons, has been a mystery for much of its 160-plus-year history in the operating room.

Anesthesia-related postoperative cognitive impairment
Source: Pain / Anesthetics News From Medical News Today [2014.11.05]
General anesthesia results in extended cognitive decline for many individuals following surgical procedure. Memory deficits can last for months and affect patient outcome and quality of life.

Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Source: MedicineNet Pregnancy Drug Dangers Specialty [2014.10.15]
Title: Risks From Epidural, Spinal Anesthesia Very Low, Study Says
Category: Health News
Created: 10/14/2014 12:00:00 AM
Last Editorial Review: 10/15/2014 12:00:00 AM

The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Source: MedicineNet Heart Attack Pathology: Photo Essay Specialty [2014.09.08]
Title: The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Category: Doctor's Views
Created: 9/8/2014 12:58:00 PM
Last Editorial Review: 9/8/2014 12:58:43 PM

more news >>

Published Studies Related to Atracurium

[Comparison of atracurium, cisatracurium and vecuronium during anaesthesia for laparoscopic surgery]. [2011.01]
BACKGROUND: The aim of the study was to compare the intubating conditions, onset time, and duration of action of atracurium, cisatracurium, and vecuronium, when used for muscle relaxation in laparoscopic surgery with carbon dioxide inflation. In trying to find an "ideal" relaxant we compared the relative potency of these drugs, and also measured pH, PaCO2 and skin temperature... CONCLUSIONS: Vecuronium, besides providing excellent conditions for tracheal intubation, had the fastest onset time and optimal duration of action. We found the drug to be the most suitable for laparoscopic surgery.

Comparative evaluation of atracurium dosed on ideal body weight vs. total body weight in morbidly obese patients. [2011.01]
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Different conflicting reports have been published for the use of atracurium in morbidly obese patients. Dosing of atracurium based on lean body mass, total body weight, and total body weight with a dose reduction for every 10 kg more than 70 kg have been proposed. WHAT THIS STUDY ADDS: The current prospective randomized double-blind study compares atracurium 0.5 mg kg(-1) ideal body weight vs. 0.5 mg kg(-1) total body weight when used as a muscle relaxant in morbidly obese patients undergoing bariatric surgery. Based on our results in patients with body weights varying from 112 to 260 kg, we have concluded that atracurium 0.5 mg kg(-1) ideal body weight results in a predictable profile of muscle relaxation allowing for adequate intubation conditions and recovery of muscle strength within 60 min with lack of need for antagonism. A dose-dependent prolongation of action is shown when dosing is based on total body weight. AIMS: This double-blind randomized study evaluated atracurium dosing based on ideal body weight vs. total body weight for muscle relaxation in morbidly obese patients undergoing bariatric surgery... CONCLUSION: In morbid obesity (112-260 kg), atracurium 0.5 mg kg(-1) ideal body weight results in a predictable profile of muscle relaxation allowing for adequate intubation conditions and recovery of muscle strength to a TOF ratio >90% within 60 min with lack of need for antagonism. A dose-dependent prolongation of action is shown when dosing is based on total body weight. (c) 2010 The Authors. British Journal of Clinical Pharmacology (c) 2010 The British Pharmacological Society.

Comparative evaluation of atracurium dosed on ideal body weight vs. total body weight in morbidly obese patients. [2011]
patients undergoing bariatric surgery... CONCLUSION: In morbid obesity (112-260 kg), atracurium 0.5 mg kg(-1) ideal body

Effect of an intravenous infusion of lidocaine on cisatracurium-induced neuromuscular block duration: a randomized-controlled trial. [2010.11]
BACKGROUND: Intravenous lidocaine can be used intraoperatively for its analgesic and antihyperalgesic properties but local anaesthetics may also prolong the duration of action of neuromuscular blocking agents. We hypothesized that intravenous lidocaine would prolong the time to recovery of neuromuscular function after cisatracurium... CONCLUSIONS: No significant prolongation of spontaneous recovery of a TOF ratio >/= 0.9 after cisatracurium was found in patients receiving intravenous lidocaine. (c) 2010 The Authors. Journal compilation (c) 2010 The Acta Anaesthesiologica Scandinavica Foundation.

Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery. [2010.09]
BACKGROUND: Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED(95) doses of cisatracurium (100 micro g/kg) do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED(95). To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium... CONCLUSION: The same dose (2xED(95) dose) atracurium is more effective neuromuscular blocking agent than cisatracurium, while higher doses of cisatracurium 4xED(95) and 6xED(95) provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, and no associated signs of histamine release clinically.

more studies >>

Clinical Trials Related to Atracurium

Peri -and Postoperative Drug Therapy Schedules for Morbidly Obese Patients [Recruiting]
Rationale: Obesity is an increasing health risk worldwide, with the USA recording prevalence in adults of around 20%. The mean body weight of obese patients is also increasing. One of the strategies to treat extreme obesity (Body Mass Index (BMI) > 40 kg/m2) is weight-reducing surgery like laparoscopic gastric banding or gastric bypass. During anaesthesia, morbidly obese patients are exposed to an increased risk at developing postoperative wound infections, apnoea and thrombotic events and may be more difficult to intubate. Routinely, amongst others, cefazolin, morphine, nadroparin and atracurium are administered in standard dosages. However, it is not known to what extend the

pharmacokinetics and/or - dynamics of these drugs are affected in morbidly obese patients.

Therefore, evidence-based dosing schedules for these drugs in morbidly obese patients should be developed.

Objective: The study is performed in order to develop population pharmacokinetic and/or pharmacodynamic models of the routinely used drug therapies during bariatric surgery in morbidly obese patients (BMI > 40 kg/m2): cefazolin, morphine, nadroparin and atracurium.

A covariate analysis will be performed in order to account for variability in pharmacokinetic and/or pharmacodynamic parameters. This covariate analysis will take into account procedure and patient bound covariates, with specific interest for body weight as a covariate. Whenever possible, non-obese patients will be included in the covariate analysis.

The results will be used to develop individualised dosing schemes for routinely used drugs peri-operatively in morbidly obese patients.

Study design: A randomised, prospective, observational, therapeutic and invasive study.

Study population: Morbidly obese patients with a Body Mass Index > 40 kg/m2 undergoing laparoscopic banding or gastric bypass surgery, 18-60 years old. A total of 20 patients will be included in the study.

Intervention (if applicable): All measurements and data collection will take place around administration of drugs that are given according to routine clinical practice (cefazolin 2 grams for prophylaxis of infections, morphine 10 mg intravenously at the end of surgery, a patient-controlled analgesia (PCA) pump with morphine for postoperative pain relief and nadroparin 0,6 ml for trombo-embolic prophylaxis). For muscle relaxation, patients are randomised to receive one of two generally accepted dosing regimen of atracurium (0. 5 mg/kg based on ideal body weight or 0. 5 mg/kg based on total body weight). Peri- and postoperatively, a maximum amount of 70 ml of blood will be collected from an indwelling arterial line for measurement of concentrations of cefazolin, morphine, and anti-Xa (nadroparin). One week after surgery the patient will be checked for thrombosis using ultrasonography.

Main study parameters/endpoints:

Primary endpoints to evaluate in morbidly obese patients are;

- pharmacokinetic parameters of cefazolin in blood;

- pharmacokinetic parameters of morphine and metabolites in blood;

- time course of anti-factor Xa levels in blood following nadroparin;

- time course of the pharmacodynamic effect of atracurium.

Secondary endpoints to evaluate in morbidly obese patients are:

- to compare primary endpoints (obtained in morbidly obese patients) with data of

non-obese patients

- the occurrence of postoperative wound infections;

- postoperative pain scores, sedation scores and nausea scores;

- the occurrence of bleedings or thrombotic events ;

- required amounts of morphine (PCA);

- to compare the time course of the pharmacodynamic effect of two different doses of


Effect of Deep BLock on Intraoperative Surgical Conditions [Recruiting]
Rationale: A deep neuromuscular block is often associated with improved surgical conditions especially in laparoscopic surgery. However, a deep block comes at the expense of a variety of items that may conflict with the use of a deep surgical muscle blockade including a long recovery phase, the need for muscle reversal, postoperative ventilation, impaired postoperative breathing. With the introduction of Sugammadex there is now the possibility to reverse an even deep surgical block. This may overcome most if not all of the issues mentioned.

Objective: To assess whether a deep neuromuscular block provides better surgical conditions than a moderately deep block as derived from a surgical rating score.

Study design: Single center, double-blind randomized controlled trial. Study population: 24 ASA I-III patients scheduled for laparoscopic renal (n=12, GROUP 1) or prostatic surgery (n=12, GROUP 2).

Intervention: In both GROUP 1 and GROUP 2, 6 six patients will receive neuromuscular blockade according to current practice (atracurium (bolus) plus mivacurium (cont. infusion)) aimed at a moderately deep neuromuscular block (1-2 twitches in the Train of Four (TOF) monitor). The other six will receive a bolus plus continuous infusion with rocuronium aimed at a deep neuromuscular block (1-2 twitches post tetanic count (PTC)). All surgical procedures will be performed by one surgeon.

Main study parameters/endpoints: To study the surgical conditions in patients undergoing laparoscopic renal or prostate surgery during deep versus less deep neuromuscular block as assessed by the surgical rating score.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Compared to current practice there will be no additional risk.

The Comparability of Bispectral Index and Neurosense During Anesthesia [Recruiting]
The assessment of anesthesia depth was based, until recently, on the evolution of hemodynamic parameters. Nowadays it can be evaluated by several monitoring methods, derived from electroencephalogram analysis, namely the Bispectral Index (Aspect Medical Systems, Newton, USA). A new modality is currently under development: the NeuroSENSE (Cleveland Medical Devices Inc., Cleveland, OH 44103, USA). The goal of this study is to compare both monitoring modalities during anesthesia.

The Effects of Anesthetic Method on Cerebral Oxygen Saturation in Geriatric Patients Undergoing Transurethral Surgery [Recruiting]

Study of Use of Paravertebral Blocks for Pain Relief in Video Assisted Lung Surgery [Not yet recruiting]
This project involves looking at the timing of providing pain relief for patients who are having lung surgery via the use of a small camera inserted into the chest with a scope (Video assisted thorascopy). This procedure can be the source of intense pain both immediately after the procedure and in the longer term leading to chronic pain problems.

Local anaesthetic placed in the paravertebral space which is located adjacent to the spinal column, where the pain nerve fibres are located, is a well recognized method of providing pain relief for these procedures. It is currently unclear as to the best timings for providing this type of pain relief with some centres placing the local anaesthetic at the start of the procedure and some at the end. Placing a high volume of local anaesthetic into this area at the start of the case may provide better short and long term pain relief than placing it at the end of the procedure. The investigators hope to show a difference between the two timings to allow for better pain relief for these procedures. This would be a feasibility study that would lead onto a multicentre trial to eventually create a best practice protocol for pain relief for lung resection via this surgical method.

more trials >>

Reports of Suspected Atracurium Side Effects

Liver Function Test Abnormal (3)Oxygen Saturation Decreased (3)Stridor (2)Pain (2)Anaphylactic Shock (2)Laryngeal Oedema (2)Erythema (2)Depression (2)Dyspnoea (2)Heart Rate Increased (2)more >>

Page last updated: 2014-11-18

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