Related Subjects:
|Respiratory Failure
|Non-invasive ventilation (NIV)
|Intubation and Mechanical Ventilation
|Critical illness neuromuscular weaknesss
|Haemodialysis
|Dobutamine
💉 Atracurium Besilate is a non-depolarising muscle relaxant commonly used to facilitate intubation and mechanical ventilation.
⚠️ Its effect is more prolonged than suxamethonium.
❌ Do not administer intramuscularly - this may cause tissue irritation and is not supported by clinical evidence.
📖 About
- Always check the BNF link here for up-to-date prescribing advice.
- Used for endotracheal intubation and mechanical ventilation.
- Eliminated by Hofmann degradation (spontaneous breakdown in plasma) → useful in patients with renal or hepatic impairment.
⚙️ Mode of Action
- Competitive, non-depolarising antagonist of acetylcholine at the neuromuscular junction.
- Prevents depolarisation of the muscle endplate → produces skeletal muscle paralysis.
💊 Indications/Dose
- Initial IV bolus: 300–600 micrograms/kg.
- Maintenance IV bolus: 100–200 micrograms/kg as required.
- Continuous infusion: 300–600 micrograms/kg/hour, titrated to response.
- ⚠️ Always induce unconsciousness first - do not give to an awake patient.
🔗 Interactions
- See BNF for full list (notably potentiated by certain antibiotics, anaesthetic agents, and electrolyte disturbances).
⚠️ Cautions
- Patients with burns (may show resistance).
- Cardiac disease and abnormal electrolytes.
- Myasthenia gravis (increased sensitivity).
⛔ Contraindications
- See BNF (generally avoid in known hypersensitivity).
💥 Side Effects
- Flushing and hypotension (due to histamine release).
- Bronchospasm.
- Skin reactions.
💡 Clinical Pearls
- Duration of action: ~20–35 minutes.
- Eliminated independently of liver/kidneys → safe in organ failure.
- Histamine release can cause transient hypotension - caution in unstable patients.
- Commonly used in ICU for ongoing paralysis as it avoids drug accumulation.
📚 References
