Tracrium [Atracurium besylate]

Adults and children over 1 month in order to relax the skeletal muscles, Trakrium is injected intravenously in a jet at a dose of 300-600 mcg / kg (which provides relaxation of the skeletal muscles for 15-35 minutes). Tracheal intubation can usually be performed within 90 seconds after intravenous administration of a dose of 500-600 mcg / kg. For prolongation of the complete neuromuscular blockade, the drug is administered additionally IV the jet at a dose of 100-200 mg / kg. The introduction of additional doses is not accompanied by cumulative effects. Spontaneous recovery to 95% occurs after 35 minutes.
After the initial bolus dose of 300-600 mcg / kg has been administered, a continuous intravenous infusion can be performed at a rate of 300-600 mcg / kg / h to maintain neuromuscular blockade during long-term surgical interventions.
Tracrium can be administered by infusion at recommended doses for coronary artery bypass surgery. The neuromuscular blockade created by Trakrium can be quickly removed with medium therapeutic doses of anticholinesterase agents (for example, neostigmine, edrofonii) with prior or subsequent administration of atropine. In hypothermia conditions (at a patient's body temperature of 25-26 ° C), the recommended doses of Trakrium should be reduced by 2 times.
When used in the intensive care unit (ICU) After the initial bolus dose of 300-600 mcg / kg has been administered, Trakrium can be used to maintain neuromuscular blockade by continuous infusion at a rate of 11 to 13 mcg / kg / min (650-780 mcg / kg / h). The spontaneous recovery of neuromuscular conductivity after Tracrium infusion in patients in the intensive care unit does not depend on the duration of drug administration. Spontaneous recovery can be expected within 60 minutes. Gaps in the 32-108 min were observed in clinical practice.
Patients with impaired renal and / or liver function at any stages, including terminal, Trakrium can be entered in the recommended doses.
Patients with cardiovascular diseases the initial dose of Trakrium should be administered within 60 seconds.
Elderly patients Trakrium can be used in the lowest recommended doses and reduce the rate of administration.

Use of the drug during pregnancy is possible only when the intended benefit to the mother outweighs the potential risk to the fetus.
In obstetric practice, Trakrium can be used as a muscle relaxant for caesarean section, because At the recommended doses of atracuria, besylate does not penetrate the placenta at clinically significant concentrations.
It is not known whether Atracurium besylate is released and its metabolites in breast milk.

Trakrium paralyzes the respiratory and other skeletal muscles, without affecting the human mind. In this regard, the drug should be used only in combination with adequate general anesthesia, under the control of an experienced anesthesiologist, and if funds are available for carrying out endotracheal intubation and mechanical ventilation.
Tracrium can promote the release of histamine (like other muscle relaxants). Therefore, care should be taken when administering it to patients with a known hypersensitivity to histamine.
At the recommended doses, Trakrium has no significant vagal or ganglion blocking action and is not contraindicated in bradycardia associated with the use of many anesthetics or vagal stimulation during surgery.
It is recommended to monitor the neuromuscular function when selecting an individual dosing regimen of Trakrium.
Patients with myastenia gravis, other neuromuscular diseases and severe electrolyte disorders may experience increased sensitivity to Trakrium (as well as to other muscle relaxants).
Patients with the risk of a significant reduction in blood pressure, for example, in hypovolemia, the administration of Trakrium should be carried out for 60 seconds.
Data from experimental and clinical studies indicate that Trakrium does not cause malignant hyperthermia.
Patients with burns may develop Trakrium resistance and may require an increase in dose, depending on the period elapsed since the time of the burn and the area of ​​the burn surface.
After insertion of Tracrium into the peripheral vein or when other drugs are injected into the same needle or cannula, the infusion system should be flushed with an adequate amount of saline.

Symptoms: prolonged myoplegia (and its possible consequences).

Treatment: IVL under positive pressure until spontaneous respiration is restored. It is necessary that the patient was under the influence of sedatives. When the first signs of spontaneous recovery of neuromuscular function appear, it can be accelerated by administering anticholinesterase drugs in combination with atropine.