General anesthesia for endotracheal intubation. During surgical procedures or conducting controlled ventilation to relax skeletal muscles. In patients in intensive care units to facilitate mechanical ventilation.
Composition:
1 ml of solution contains 10 mg of atracurium benzenesulfonate.
Action:
Highly specific, non-depolarizing drug blocking neuromuscular transmission, showing an average duration of action. It causes relaxation of muscles striated by competition against acetylcholine on motor plate receptors. In the body at physiological pH and normal body temperature, it undergoes non-enzymatic decomposition (Hofmann type) to inactive products and by hydrolysis of ester bonds by non-specific esterases. Quaternary alcohol is spontaneously decomposed in Hofmann's elimination and excreted in the urine. The second metabolite - laudanosine - is excreted in the urine and metabolized in the liver. T0,5 laudanosine is 3-6 h in patients with normal kidney and liver function; it extends to 15 hours in renal failure and up to 40 hours in renal and hepatic failure. The elimination of atracurium is not dependent on the capacity of the kidneys or liver; T0,5 is about 20 min.
Contraindications:
Hypersensitivity to atracurium, cisatracurium or benzenesulfonic acid.
Precautions:
Caution should be exercised in patients with myasthenia gravis and other neuromuscular diseases, with severe acid-base or electrolyte disturbances, in patients who have experienced histamine reactions and hypovolaemia and burns after histamine medications. Monitoring of serial phosphocreatine kinase (CPK) values should be taken into account when administering neuromuscular blocking agents to patients with high-dose corticosteroid-treated bronchial asthma treated with ICUs. There are no data on the safety and efficacy of the drug in children under 1 month of age.
Pregnancy and lactation:
The preparation can be used during pregnancy only if the expected benefit to the mother outweighs the potential risk to the fetus. It can be used under anesthesia for Caesarean section. It is not known whether the drug is excreted in breast milk.
Side effects:
Reactions associated with the release of histamine: often - sudden redness of the skin, transient, mild lowering of blood pressure; uncommon - bronchospasm. It is possible very rarely to have anaphylactic and anaphylactoid reactions, as well as convulsions, myopathy, weakness in muscle strength. There have been reports of convulsive seizures in patients receiving an atracurial infusion under intensive care, but no causal relationship with laudanosine has been proven. In clinical trials, there was no correlation between plasma concentration of laudanosine and seizures.
Dosage:
The preparation may be administered only by anesthesiologists or under their supervision and in conditions that ensure the possibility of artificial ventilation of the patient. Intravenous - adults and children over 1 month of age: intubation dose - 0.5-0.6 mg / kg, initial dose in patients intubated with another agent: 0.3-0.6 mg / kg, supporting 0.1-0.2 mg / kg Intravenous infusion (after a loading dose of 0.3-0.6 mg / kg): maintenance dose: 0.3-0.6 mg / kg / h. Doses in cardioanesthesia using extracorporeal circulation: in normothermia - as above, in medium hypothermia - reduced by 50%. In ICU conditions: initial dose 0.3-0.6 mg / kg; continuous infusion of 11-13 μg / kg / min (under these conditions a significant range of necessary doses was observed: from 4.5 μg / kg / min to 29.5 μg / kg / min). In renal or hepatic failure - standard doses; in the elderly - standard doses, closer to the lower limit recommended. Optimal dosing is achieved by monitoring relaxation using a peripheral nerve stimulator. When administered into an intravenous cannula with other medications - after each medication, flush the 0.9% NaCl cannula. The drug can be diluted with fluids for intravenous infusion: 0.9% NaCl solution (24 h), 5% Glucose solution (8 h), Ringer's solution (8 h), liquid 0.18% NaCl solution in 4% glucose (8 h ), Hartmann's liquid (4 h) in such a dilution that the concentration of atracurium is not less than 0.5 mg / ml (in parentheses, the period of stability of the preparation depending on the infusion fluid at temperature <30 ° C in daylight).
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