Metabolism atracurium besylate is inactivated by Hofmann elimination (a process which occurs at physiological pH and temperature without enzymes) and by ester hydrolysis, with the participation of non-specific esterases. Studies of plasma in patients with low pseudocholinesterase shown that atracurium metabolites besylate not changed. Changes in the values of blood pH and body temperature in the physiological range have little effect on the duration of action of atracurium besylate.
Withdrawal duration of neuromuscular blockade induced halotest 25 reviews by administration of atracurium besylate is independent from its metabolism in the liver or kidney or excretion. It is therefore unlikely that the duration of action of the drug varies with impaired renal function, hepatic or circulatory disorders.
Special patient groups hemofiltration and hemodiafiltration have a minimal effect on the concentration of atracurium besylate and its metabolites (including laudanozin) in the blood plasma. The influence of hemodialysis and hemoperfusion on the concentration of atracurium besylate and its metabolites in the blood plasma is unknown. In patients of intensive care unit with impaired renal and / or hepatic impairment had higher concentrations of metabolites of atracurium besylate. The metabolites have no effect on neuromuscular conduction.
- as a component of general anesthesia for tracheal intubation of and relaxation of skeletal muscles during surgery or controlled ventilation, and to facilitate the artificial lung ventilation for patients in the intensive care unit .
- known hypersensitivity to atracurium, or tsisatrakuriyu benzylsulfonic acid, any other components of the preparation.
- Known hypersensitivity to histamine
in susceptible patients can cause the development of reactions associated with the release of histamine. Caution should be exercised when administered to patients with instructions Trakriuma a history of hypersensitivity to the effects of histamine.
Caution is also required when administered patients who were observed hypersensitivity reactions to other muscle relaxants, as revealed a high frequency halotest 25 reviews of cross-reactivity between the occurrence of muscle relaxants (more 50%) . (see. Contraindications ).
As with other non-depolarizing neuromuscular blocking agents, increased sensitivity to Trakriumu may occur in patients with myasthenia gravis, other neuromuscular disease and severe electrolyte imbalance.
Dosage and administration of pharmaceutical compatibility with some infusion solutions, see “Interaction with other medicinal products and other interactions.”
- Injection application in adults
Trakrium administered intravenously by injection. For adults, a dose range of 0.3-0.6 mg / kg (depending on the desired duration of complete blockage) that provides adequate mioplegii for 15-35 min.
After intravenous doses of 0.5-0.6 mg / kg endotracheal intubation can be carried out, usually after 90 seconds.
If you want to prolong the total neuromuscular blockade Trakrium additionally introduced at a dose of 0.1-0.2 mg / kg. Proper administration of additional doses of the drug does not lead to accumulation miorelaksiruyuschego effect.
Spontaneous recovery after a complete conduction of neuromuscular blockade occurs in about 35 minutes, as measured by the restoration of tetanic reduction of up to 95% of normal neuromuscular function. Neuromuscular blockade caused atracurium can be quickly resolved by applying anticholinesterase agents at standard doses, such as neostigmine and edrophonium, combined with simultaneous or prior administration of atropine (without showing signs rekurarizatsii).
- Infusion use in adults
after the initial bolus dose of 0.3-0.6 mg / kg halotest 25 reviews can be used to maintain neuromuscular blockade during long surgery by continuous infusion at a rate of 0.3-0.6 mg / kg / h. Trakrium may be administered by infusion during surgery to bypass kardionulmonarnogo recommended rate infusion. When induced hypothermia with a body temperature of 25 ° to 26 ° C reduced rate of inactivation Trakriuma thus to maintain full miorelaxation at low temperatures reduce the rate of infusion of about 2 times.