Atrium Special Precautions

Atracurium Besilate Injection should be used only by those skilled in the management of artificial respiration and only when facilities are immediately available for endotracheal intubation and for providing adequate ventilation support, including the administration of oxygen under positive pressure and the elimination of carbon dioxide. The clinician must be prepared to assist or control ventilation, and anticholinesterase agents should be immediately available for reversal of neuromuscular blockade.
Atracurium has no known effect on consciousness, pain threshold, or cerebration. In surgery, it should be used only with adequate general anesthesia.
In common with other neuromuscular blocking agents, the potential for histamine release exists in susceptible patients during administration of atracurium besilate. Caution should be exercised in patients with a history suggestive of an increased sensitivity to the effects of histamine.
Do not give Atracurium Besilate Injection by intramuscular administration.
Atracurium Besilate Injection has an acid pH and therefore should not be mixed with alkaline solutions (e.g. barbiturate solutions) in the same syringe or administered simultaneously during intravenous infusion through the same needle. Depending on the resultant pH of such mixtures, Atracurium Besilate Injection may be inactivated and a free acid may be precipitated.
When a small vein is selected as the injection site, Atracurium Besilate Injection should be flushed through the vein with physiological saline after injection. When other anesthetic drugs are administered through the same indwelling needle or cannula as Atracurium Besilate Injection, it is important that each drug is flushed through with an adequate volume of physiological saline.
Atracurium may have profound effects in patients with myasthenia gravis, Eaton-Lambert syndrome, or other neuromuscular diseases in which potentiation of non-depolarising agents has been noted. A reduced dosage of atracurium and the use of a peripheral nerve stimulator for assessing neuromuscular blockade is especially important in these patients. Similar precautions should be taken in patients with severe electrolyte disorders.
Atracurium does not have significant vagal or ganglion blocking properties in the recommended dosage range. Consequently, atracurium will not counteract the bradycardia produced by many anesthetics agents or by vagal stimulation during surgery. Therefore, bradycardia during anesthesia may be more common with atracurium than with other muscle relaxants.
As with other non-depolarising neuromuscular blocking agents, resistance to atracurium may develop in patients suffering from burns. Such patients may require increased doses of atracurium depending on the time elapsed since the burn injury and the extent of the burn.
Atracurium Besilate Injection should be administered over a period of at least 60 seconds to patients who may be unusually sensitive to falls in arterial blood pressure, for example those who are hypovolemic.
Atracurium Besilate Injection is hypotonic and must not be applied into the infusion line of a blood transfusion.
Monitoring of serial creatine phosphokinase (CPK) values should be considered in asthmatic patients receiving high dose corticosteroids and neuromuscular blocking agents in intensive care units.
Special precautions should be taken in patients with known anaphylactic reactions to curares, as cross-reactivity may be possible with this product.
Effects on ability to drive and use machines: It is not recommended to use potentially dangerous machinery or drive a car within 24 hours after full recovery from the neuromuscular blocking action of atracurium.