ATRACURIUM BESYLATE Pr

(a-tra-kyoor’ee-um)

Classifications: NONPOLARIZING SKELETAL MUSCLE RELAXANT; NEUROMUSCULAR

BLOCKER

Therapeutic: SKELETAL MUSCLE RELAXANT

Pregnancy Category: C

Availability: 10 mg/mL injection

Action & Therapeutic Effect: Inhibits neuromuscular transmission by

binding competitively with acetylcholine to muscle end plate receptors.
Given in general anesthesia only after unconsciousness has been
induced by other drugs. Synthetic skeletal muscle relaxant that produces
short duration of neuromuscular blockade, exhibits minimal direct effects
on cardiovascular system, and has less histamine-releasing action.

Uses: Adjunct for general anesthesia to produce skeletal muscle

relaxation during surgery; to facilitate endotracheal intubation.
Especially useful for patients with severe renal or hepatic disease,
limited cardiac reserve, and in patients with low or atypical
pseudocholinesterase levels.

Contraindications: Myasthenia gravis.

Cautious Use: When appreciable histamine release would be hazardous

(as in asthma or anaphylactoid reactions, significant cardiovascular
disease), neuromuscular disease (e.g., Eaton-Lambert syndrome),
carcinomatosis, electrolyte or acid–base imbalances, dehydration,
impaired pulmonary function; pregnancy (category C), lactation;
children under 1 mo.

Route & Dosage

Skeletal Muscle Relaxation

Adult/Child (2 y or older): IV 0.4–0.5 mg/kg initial dose, then

0.08–0.1 mg/kg bolus 20–45 min after the first dose and q15–25 min
thereafter; reduce doses if used with general anesthetics

Child (1 mo–2 y): IV 0.3–0.4 mg/kg

Common adverse effects in italic, life-threatening effects underlined; generic names

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Atracurium Besylate. In Pearson Nurse’s
Drug Guide 2012 (pp. 132–134). Upper Saddle River, NJ: Prentice Hall. 1
in bold; classifications in SMALL CAPS; Canadian drug name; Pr Prototype drug
Mechanical Ventilation

Adult: IV 5–9 mcg/kg/min by continuous infusion

Administration
• Verify correct concentration and rate of infusion for infants and
children with prescriber.

Intravenous

Prepare: Direct: Give initial bolus dose undiluted. Continuous:

Maintenance dose must be diluted with NS, D5W or D5/NS. Maximum
concentration should be 0.5 mg/mL. Do not mix in same syringe or
administer through same needle as used for alkaline solutions
[incompatible with alkaline solutions (e.g., barbiturates)].

Administer: Direct: Give as bolus dose over 30–60 sec. Continuous:

Give infusion at rate required to maintain desired effect.

Incompatibilities: Solution/additive: Lactated Ringer’s,

aminophylline, cefazolin, heparin, nitroprusside quinidine,
ranitidine, sodium nitroprusside. Y-site: Aminophylline,
amphotericin B, cefonicid, cefoperazone, cefoxitin, ceftazidime,
dantrolene, diazepam, diazoxide, furosemide, ganciclovir,
indomethacin, pantoprazole, pentobarbital, phenobarbital,
phenytoin, propofol, sodium bicarbonate, thiopental.
• Store at 2°–8° C (36°–46° F) to preserve potency unless
otherwise directed. Avoid freezing.

Adverse Effects (≥1%): CV: Bradycardia, tachycardia. Respiratory:

Respiratory depression. Other: Increased salivation, anaphylaxis.

Interactions: Drug: GENERAL ANESTHETICS increase magnitude and

duration of neuromuscular blocking action; AMINOGLYCOSIDES,
bacitracin, polymyxin B, clindamycin, lidocaine, parenteral
magnesium, quinidine, quinine, trimethaphan, verapamil
increase neuromuscular blockade; DIURETICS may increase or decrease
neuromuscular blockade; lithium prolongs duration of neuromuscular
blockade; NARCOTIC ANALGESICS present possibility of additive respiratory
depression; succinylcholine increases onset and depth of
neuromuscular blockade; phenytoin may cause resistance to or
reversal of neuromuscular blockade.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Atracurium Besylate. In Pearson Nurse's
2 Drug Guide 2012 (pp. 132–134). Upper Saddle River, NJ: Prentice Hall.
Pharmacokinetics: Onset: 2 min. Peak: 3–5 min. Duration:
60–70 min. Distribution: Well distributed to tissues and extracellular
fluids; crosses placenta; distribution into breast milk unknown.
Metabolism: Rapid nonenzymatic degradation in bloodstream.
Elimination: 70–90% in urine in 5–7 h. Half-Life: 20 min.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Baseline serum electrolytes, acid–base balance, and
renal function as part of preanesthetic assessment.
• Note: Personnel and equipment required for endotracheal
intubation, administration of oxygen under positive pressure,
artificial respiration, and assisted or controlled ventilation must
be immediately available.
• Evaluate degree of neuromuscular blockade and muscle paralysis
to avoid risk of overdosage by qualified individual using
peripheral nerve stimulator.
• Monitor BP, pulse, and respirations and evaluate patient’s
recovery from neuromuscular blocking (curare-like) effect as
evidenced by ability to breathe naturally or to take deep breaths
and cough, keep eyes open, lift head keeping mouth closed,
adequacy of hand-grip strength. Notify prescriber if recovery is
delayed.
• Note: Recovery from neuromuscular blockade usually begins
35–45 min after drug administration and is almost complete in
about 1 h. Recovery time may be delayed in patients with
cardiovascular disease, edematous states, and in older adults.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Atracurium Besylate. In Pearson Nurse’s
Drug Guide 2012 (pp. 132–134). Upper Saddle River, NJ: Prentice Hall. 3