Tracrium Dosage/Direction for Use

In common with all neuromuscular blocking agents monitoring of neuromuscular function is recommended during the use of atracurium in order to individualise dosage requirements.
Use by injection in adults: Atracurium is administered by intravenous (i.v.) injection. The dosage range for adults is 0.3 to 0.6 mg/kg (depending on the duration of full block required) and will provide adequate relaxation for about 15 to 35 minutes.
Endotracheal intubation can usually be accomplished within 90 seconds from the i.v. injection of 0.5 to 0.6 mg/kg.
Full block can be prolonged with supplementary doses of 0.1 to 0.2 mg/kg as required.
Successive supplementary dosing does not give rise to accumulation of neuromuscular blocking effect.
Spontaneous recovery from the end of full block occurs in about 35 minutes as measured by the restoration of the tetanic response to 95% of normal neuromuscular function.
The neuromuscular block produced by atracurium can be rapidly reversed by standard doses of anticholinesterase agents, such as neostigmine and edrophonium, accompanied or preceded by atropine, with no evidence of recurarisation.
Use as an infusion in adults: After an initial bolus dose of 0.3 to 0.6 mg/kg, atracurium can be used to maintain neuromuscular block during long surgical procedures by administration as a continuous infusion at rates of 0.3 to 0.6 mg/kg/h.
Atracurium can be administered by infusion during cardiopulmonary bypass surgery at the recommended infusion rates. Induced hypothermia to a body temperature of 25° to 26°C reduces the rate of inactivation of atracurium, therefore full neuromuscular block may be maintained by approximately half the original infusion rate at these low temperatures.
Atracurium is compatible with the following infusion solutions for the times stated as follows: (See Table 1.)

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When diluted in these solutions to give atracurium concentrations of 0.5 mg/mL and above, the resultant solutions will be stable in daylight for the stated periods at temperatures of up to 30°C.
Use in children: The dosage in children over the age of 1 month is the same as that in adults on a bodyweight basis.
Use in the elderly: Atracurium may be used at standard dosage in elderly patients. It is recommended, however, that the initial dose be at the lower end of the range and that it be administered slowly.
Use in patients with reduced renal and/or hepatic function: Atracurium may be used at standard dosage at all levels of renal or hepatic function, including end-stage failure.
Use in patients with cardiovascular disease: In patients with clinically significant cardiovascular disease, the initial dose of atracurium should be administered over a period of 60 seconds.
Use in Intensive Care Unit (ICU) patients: After an optional initial bolus dose of atracurium of 0.3 to 0.6 mg/kg, atracurium can be used to maintain neuromuscular block by administering a continuous infusion at rates of between 11 and 13 micrograms/kg/min (0.65 to 0.78 mg/kg/h). However, there is a wide inter-patient variability in dosage requirements. Dosage requirements may change with time. Infusion rates as low as 4.5 micrograms/kg/min (0.27 mg/kg/h) or as high as 29.5 micrograms/kg/min (1.77 mg/kg/h) are required in some patients.
The rate of spontaneous recovery from neuromuscular block after infusion of atracurium in ICU patients is independent of the duration of administration. Spontaneous recovery to a train-of-four ratio greater than 0.75 (the ratio of the height of the fourth to the first twitch in a train-of-four) can be expected to occur in approximately 60 minutes. A range of 32 to 108 minutes has been observed in clinical trials.