Dose:   0.3 to 0.5 mg/kg IV as a single dose or a loading dose
              5 to 10 mcg/kg/min as a continuous infusion

Frequency: Continuous infusion

Comments: Atracurium is a nondepolarizing neuromuscular blocking agent (NMB) with a very brief duration of action (usually less than one hour).   Effects should be seen within one to four minutes after the drug is administered. It is inactivated spontaneously in plasma. The duration of neuromuscular blockade is not effected by renal or hepatic dysfunction.  There is also no cumulative effect following repeated doses, large doses, or continuous infusions.  Recovery from paralysis should be seen within one after after discontinuing a continuous infusion. See NMB Table for comparison with other NMB agents. Although atracurium has the potential for histamine release it has rarely proven to be a clinical problem. The principle danger in using atracurium is the inadvertent development of hypoxemia or hypoventilation in the infant. Sometimes it is difficult to determine the extent to which the infant is dependent upon his own respiratory drive until after the drug is administered. If this proves to be a significant component, then one must be ready to increase ventilator support or to reverse the neuromuscular blockade immediately.  More comments on atracurium.

Preparation:
IV:Atracurium (Tracrium) is available as a preservative-free preparation in a 50 mg/5 ml vial (10 mg/ml). Non preservative-free preparations contain benzyl alcohol. If necessary, atracurium may be further dilated in NS or D5W. Spontaneous degradation of atracurium has been demonstrated to occur more rapidly in lactated ringers solution than in normal saline solutions. Stable for 24 hours after dilution whether stored under refrigeration or not. Store unopened vials under refrigeration. If removed from refrigeration, vial should be used within 2 weeks. The cost per vial of atracurium is about three times that of mivacurium.

Atracurium drip.

Compatibility: No information available on filter, compatible with TPN. Atracurium can be prepared in D5NS, D5W, or NS. It is compatible with dobutamine, dopamine, epinephrine, esmolol, fentanyl, gentamicin, heparin, hydrocortisone, isoproterenol, lidocaine, lorazepam, midazolam, morphine, procainamide, trimethoprim-sulfamethoxazole, and vancomycin. It is incompatible with aminophylline, diazepam, and high concentrations of heparin. It has equivocal compatibility with cefazolin, ranitidine, and sodium nitroprusside.