Understanding Anesthesiology - The Global Regional Anesthesia ...

CIS-ATRACURIUM
Class
Non-depolarizing skeletal muscle relaxant (NDMR);
intermediate-acting
Mechanism of Action
Competitive inhibitor at the acetylcholine receptors of
the post-synaptic cleft of the neuromuscular junction.
Dose
Intubation: 0.15-0.2 mg/kg
Maintenance bolus: 0.03 mg/kg
Maintenance infusion: 1-2 $g/kg/minute
Onset
Dose-dependent:
2 minutes (0.15 mg/kg)
1.5 minutes (0.2 mg/kg)
Duration
Dose dependent:
Effects
MSK
The neuromuscular blockade effects of non-depolarizing
muscle relaxants are potentiated by succinylcholine,
volatile anesthetics, aminoglycosides, lithium, loop diuretics,
lidocaine, magnesium, lithium, ganglionic blockers,
hypothermia, hypokalemia and respiratory acidosis.
Enhanced neuromuscular blockade is seen in patients
with myasthenia gravis or myopathies.
The effects of NDMR are antagonized by cholinesterase
inhibitors. Increased resistance to NDMR is seen in patients
on theophylline, burn patients and those with paresis
or paralysis.
Misc.
Histamine release may occur with rapid administration
or higher dosages. Produces 5-10x less laudanosine metabolite
than atracurium. Muscle relaxants are the most
common cause of anaphylactoid reactions under general
anesthesia.
55 minutes (0.15 mg/kg)
65 minutes (0.2 mg/kg)
20 minutes (maintenance bolus 0.03 mg/kg)
Elimination
Hoffman elimination (77%), renal (16%)
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