Alternate Name(s):
TRACRIUM®
Classification:
Non-depolarizing neuromuscular agent
Original Date:
August 2005
Revised Date:
September 2011
Indications:
- To facilitate endotracheal intubation
- To provide skeletal muscle relaxation during surgery or mechanical ventilation
Reconstitution and Stability:
- Available as a 10 mg/mL aqueous solution, pH 3.25-3.65
- Refrigerate vials 2°C - 8°C. DO NOT freeze.
- Vials stable for up to 14 days at room temperature
- Diluted solutions stable 24 hrs at room temperature or refrigerated
Compatibility:
- Solutions Compatible: D5W, NS
- Additives/Above Cassette Compatible: KCl (up to 80 mmol/L)
- Y-site Compatible: dobutamine, dopamine, epinephrine, fentanyl, midazolam, milrinone, morphine
- Incompatible: alkaline solutions (e.g., sodium bicarbonate, barbiturates), ringer's lactate
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO, tissue irritation |
| IV Direct | YES, critical care areas only Usual dilution: 10 mg/mL (undiluted) Infusion time: 1 minute |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | YES Usual dilution: 0.2-0.5 mg/mL |
- NB: For patients with increased risk from histamine reaction, the dose should be administered slowly over 1-2 minutes
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Infants/Children(< 2 years):
- 0.3-0.4 mg/kg IV initially, followed by maintenance doses of 0.3-0.4 mg/kg IV as needed to maintain neuromuscular blockade OR
- Continuous infusion: 0.6 - 1.2 mg/kg/hr IV or 10-20 mcg/kg/minute IV
Children > years and Adults:
- 0.4-0.5 mg/kg IV, then 0.08-0.1 mg/kg IV 20-45 minutes after initial dose to maintain neuromuscular blockade OR
- Continuous infusion: 0.4 - 0.8 mg/kg/hr IV or 6.7-13 mcg/kg/min IV (range: 2-15 mcg/kg/min)
Dosage Reductions:
- Reduce dosage by 33% for patients on isoflurane or enflurane.
- Reduce dose for patients on succinylcholine or halothane.
- Reduce dosage by 50% for patients with induced hypothermia (cardio-bypass surgery)
Potential hazards of parenteral administration:
- Thought to be relatively free of cardiovascular effects when used in doses <0.5 mg/kg
- Occasional patients have slight to moderate histamine release which will result in effects such as vasodilation, flushing, occasional rashes, hypotension and bronchospasm
- The incidence of hypotension is increased in patients with a history of cardiovascular disease
- Infants have lower incidence of flushing, rash and histamine release
- Use with caution in patients with a history of cardiovascular disease, asthma, allergies or severe electrolyte disorders; the recommended initial dose is lower than for other patients
Notes:
- Atracurium is metabolized in plasma by a nonenzymatic reaction called Hofmann elimination and is minimally dependent upon renal or hepatic function for elimination
- Onset of action is 2 minutes; peak effect: within 3-5 minutes; duration 20-35 minutes
- The effects are potentiated by prior administration of any volatile inhalation anesthetic and the dose should be reduced
- Reversal of neuromuscular blockade can be accomplished by means of neostigmine or edrophonium combined with an anticholinergic agent such as atropine or glycopyrrolate
- Monitor muscle twitch response to peripheral nerve stimulation, heart rate, blood pressure