Tracrium

Adjunct to general anaesth to enable tracheal intubation to be performed, to relax skeletal muscles during surgery or controlled ventilation, & to facilitate mechanical ventilation in ICU patients.

IV Adult Inj: 0.3-0.6 mg/kg (depending on the duration of full block required). Full block can be prolonged w/ supplementary doses of 0.1-0.2 mg/kg as required. Infusion: After initial bolus dose of 0.3-0.6 mg/kg, administer as continuous infusion at 0.3-0.6 mg/kg/hr to maintain neuromuscular block during long surgical procedures. Childn >1 mth Adult dose on a body wt basis. Elderly Use at standard dosage. Initial dose should be at the lower end of the range & administered slowly. Patient w/ renal &/or hepatic impairment Use at standard dosage. Patient w/ CV disease Administer initial dose over a period of 60 sec. ICU patient After optional initial bolus dose of 0.3-0.6 mg/kg, administer as continuous infusion at 11-13 mcg/kg/min (0.65-0.78 mg/kg/hr) to maintain neuromuscular block.

Hypersensitivity to atracurium, cisatracurium or benzenesulfonic acid.

Should be administered only w/ adequate general anaesth & only by or under close supervision of an experienced anaesthetist w/ adequate facilities for endotracheal intubation & artificial ventilation. Potential for histamine release in susceptible patients during administration. Caution in patients w/ history of increased sensitivity to effects of histamine. Bronchospasm may occur in patients w/ history of allergy & asthma. Exclude hypersensitivity to other neuromuscular blocking agents before administration due to high rates of cross-sensitivity. Consider monitoring of serial creatinine phosphate values in asthmatic patients receiving high-dose corticosteroids & neuromuscular blocking agents in ICU. Increased sensitivity in patients w/ myasthenia gravis & other forms of neuromuscular disease. Severe acid-base &/or serum electrolyte abnormalities may increase or decrease sensitivity of patients to Tracrium. Hypophosphataemia may prolong recovery. Administer over a period of 60 sec to patients who may be unusually sensitive to falls in arterial BP eg, hypovolaemic patients. Resistance may develop in patients suffering from burns. Must not be mixed in the same syringe w/ thiopentone or any alkaline agent. Must not be administered into the infusion line of a blood transfusion. Should be used during pregnancy only if potential benefit to mother outweighs any potential risk to foetus. Not known if excreted in human milk.

Hypotension (mild, transient), skin flushing.

Increased neuromuscular block w/ inhalational anaesth (eg, halothane, isoflurane, enflurane). Increased magnitude &/or duration of non-depolarising neuromuscular block w/ antibiotics, including aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin, clindamycin; antiarrhythmic drugs (propranolol, Ca channel blockers, lidocaine, procainamide, quinidine); diuretics (furosemide, mannitol, thiazide diuretics, acetazolamide); Mg sulphate; ketamine; lithium salts; ganglion blocking agents (trimetaphan, hexamethonium). Co-administration w/ various antibiotics, β-blockers (propranolol, oxprenolol), antiarrhythmic drugs (procainamide, quinidine), antirheumatic drugs (chloroquine, D-penicillamine), trimetaphan, chlorpromazine, steroids, phenytoin & lithium may aggravate or unmask latent myasthenia gravis or induce myasthenic syndrome. Lengthened onset of non-depolarising neuromuscular block & shortened duration of block w/ chronic anticonvulsant therapy. Synergistic effect w/ combinations of non-depolarising neuromuscular blocking agents. Prolonged & complex block w/ depolarising muscle relaxants (eg, suxamethonium Cl). Shortened duration & diminished magnitude of neuromuscular blockade w/ anticholinesterases (eg, donepezil).

Neuromuscular Blocking Agents

M03AC04 - atracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

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