Tracrium Special Precautions

In common with all the other neuromuscular blocking agents atracurium paralyses the respiratory muscles as well as other skeletal muscles but has no effect on consciousness. Atracurium should be administered only with adequate general anaesthesia and only by or under the close supervision of an experienced anaesthetist with adequate facilities for endotracheal intubation and artificial ventilation.
The potential for histamine release exists in susceptible patients during atracurium administration. Caution should be exercised in administering atracurium to patients with a history suggestive of an increased sensitivity to the effects of histamine.
Caution should also be exercised when administering atracurium to patients who have shown hypersensitivity to other neuromuscular blocking agents since a high rate of cross-sensitivity (greater than 50%) between neuromuscular blocking agents has been reported (see Contraindications).
Atracurium does not have significant vagal or ganglionic blocking properties in the recommended dosage range. Consequently, atracurium has no clinically significant effects on heart rate in the recommended dosage range and it will not counteract the bradycardia produced by many anaesthetic agents or by vagal stimulation during surgery.
In common with other non-depolarising neuromuscular blocking agents, increased sensitivity to atracurium may be expected in patients with myasthenia gravis, other forms of neuromuscular disease and severe electrolyte imbalance.
Atracurium should be administered over a period of 60 seconds to patients who may be unusually sensitive to falls in arterial blood pressure, for example those who are hypovolaemic.
Atracurium is inactivated by high pH and so must not be mixed in the same syringe with thiopentone or any alkaline agent.
When a small vein is selected as the injection site, atracurium should be flushed through the vein with physiological saline after injection.
When other anaesthetic drugs are administered through the same in-dwelling needle or cannula as atracurium, it is important that each drug is flushed through with an adequate volume of physiological saline.
Atracurium is hypnotic and must not be administered into the infusion line of a blood transfusion.
Studies in malignant hyperthermia in susceptible animals (swine) and clinical studies in patients susceptible to malignant hyperthermia indicate that atracurium does not trigger this syndrome.
In common with other non-depolarising neuromuscular blocking agents, resistance may develop in patients suffering from burns. Such patients may require increased doses dependent on the time elapsed since the burn injury and the extent of the burn.
Intensive Care Unit (ICU) Patients: When administered to laboratory animals in high doses, laudanosine, a metabolite of atracurium, has been associated with transient hypotension and in some species, cerebral excitatory effects. Although seizures have been seen in ICU patients receiving atracurium, a causal relationship to laudanosine has not been established (see Adverse Reactions).
Effects on Ability to Drive and Use Machines: This precaution is not relevant to the use of atracurium. Atracurium will always be used in combination with a general anaesthetic and therefore the usual precautions relating to performance of tasks following general anaesthesia apply.