▶Child:Initially 300 – 600 micrograms/kg, then (by
intravenous injection) 100 – 200 micrograms/kg,
repeated if necessary, alternatively (by intravenous
injection) initially^300 –^600 micrograms/kg, followed by
(by intravenous infusion)
300 – 600 micrograms/kg/hour, adjusted according to
response
Neuromuscular blockade during intensive care
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 300 – 500 micrograms/kg, followed by
(by intravenous injection) 100 – 200 micrograms/kg,
repeated if necessary, alternatively (by intravenous
infusion) 300 – 400 micrograms/kg/hour, adjusted
according to response, higher doses may be necessary.▶Child:Initially 300 – 600 micrograms/kg, initial dose is
optional, then (by intravenous infusion)
270 – 1770 micrograms/kg/hour; (by intravenous
infusion) usual dose 650 – 780 micrograms/kg/hour
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.lUNLICENSED USENot licensed for use in neonates.
lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTS
▶Rare or very rareCardiac arrest
▶Frequency not knownSeizure
SIDE-EFFECTS, FURTHER INFORMATIONHypotension, skin
flushing, and bronchospasm is associated with histamine
release. Manufacturer advises minimising effects of
histamine release by administering over 1 minute in
patients with cardiovascular disease or sensitivity to
hypotension. Neonates may be more sensitive to the
effects of atracurium and lower doses may be required.
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusion, dilute to a concentration of
0. 5 – 5 mg/mL with Glucose 5 % or Sodium Chloride 0. 9 %;
stability varies with diluent.
Neonatal intensive care, dilute 60 mg/kg body-weight to a
final volume of 50 mL with Glucose 5 % or Sodium Chloride
0. 9 %; minimum concentration of 500 micrograms/mL,
maximum concentration of 5 mg/mL; an intravenous
infusion rate of 0. 1 mL/hour provides a dose of
120 micrograms/kg/hour.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Atracurium besilate (Non-proprietary)
Atracurium besilate 10 mg per 1 mlAtracurium besilate
250 mg/ 25 ml solution for injection vials| 1 vialP£ 16. 50 (Hospital
only)
Atracurium besilate 25 mg/ 2. 5 ml solution for injection ampoules|
5 ampouleP£ 9. 25 (Hospital only)| 5 ampouleP£ 9. 25
Atracurium besilate 50 mg/ 5 ml solution for injection ampoules|
5 ampouleP£ 17. 50 (Hospital only)| 5 ampouleP£ 17. 50
▶Tracrium(Aspen Pharma Trading Ltd)
Atracurium besilate 10 mg per 1 mlTracrium 250 mg/ 25 ml solution
for injection vials| 2 vialP£ 25. 81
Tracrium 25 mg/ 2. 5 ml solution for injection ampoules|
5 ampouleP£ 8. 28
Tracrium 50 mg/ 5 ml solution for injection ampoules|
5 ampouleP£ 15. 02eiiiiF 813Cisatracurium
lINDICATIONS AND DOSE
Neuromuscular blockade (intermediate duration) during
surgery
▶INITIALLY BY INTRAVENOUS INJECTION
▶Child 1 month–1 year:Initially 150 micrograms/kg, then
(by intravenous injection) 30 micrograms/kg every
20 minutes as required
▶Child 2–11 years:Initially 150 micrograms/kg,
80 – 100 micrograms/kg if not for intubation, then (by
intravenous injection) 20 micrograms/kg every
10 minutes as required, alternatively (by intravenous
injection) initially 150 micrograms/kg, followed by (by
intravenous infusion) 180 micrograms/kg/hour, (by
intravenous infusion) reduced to
60 – 120 micrograms/kg/hour, adjusted according to
response
▶Child 12–17 years:Initially 150 micrograms/kg, then (by
intravenous injection) 30 micrograms/kg every
20 minutes as required, alternatively (by intravenous
injection) initially 150 micrograms/kg, followed by (by
intravenous infusion) 180 micrograms/kg/hour, (by
intravenous infusion) reduced to
60 – 120 micrograms/kg/hour, adjusted according to
response
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.lINTERACTIONS→Appendix 1 : neuromuscular blocking
drugs, non-depolarising
lSIDE-EFFECTS
▶Common or very commonBradycardia
lDIRECTIONS FOR ADMINISTRATIONForcontinuous
intravenous infusion, dilute to a concentration of
0. 1 – 2 mg/mL with Glucose 5 % or Sodium Chloride 0. 9 %;
solutions of 2 mg/mL and 5 mg/mL may be infused
undiluted.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Cisatracurium (Non-proprietary)
Cisatracurium (as Cisatracurium besilate) 2 mg per
1mlCisatracurium besilate 20 mg/ 10 ml solution for injection
ampoules| 5 ampouleP£ 32. 09
Cisatracurium besilate 20 mg/ 10 ml solution for injection vials|
5 vialP£ 37. 75 (Hospital only)
Cisatracurium (as Cisatracurium besilate) 5 mg per
1mlCisatracurium besilate 150 mg/ 30 ml solution for injection vials|
1 vialP£ 45. 00 (Hospital only)| 1 vialP£ 26. 43 – £ 29. 54
▶Nimbex(Aspen Pharma Trading Ltd)
Cisatracurium (as Cisatracurium besilate) 2 mg per 1 mlNimbex
20 mg/ 10 ml solution for injection ampoules| 5 ampouleP£ 37. 75
Cisatracurium (as Cisatracurium besilate) 5 mg per 1 mlNimbex
Forte 150 mg/ 30 ml solution for injection vials| 1 vialP£ 31. 09eiiiiF 813Mivacurium
lINDICATIONS AND DOSE
Neuromuscular blockade (short duration) during surgery
▶INITIALLY BY INTRAVENOUS INJECTION
▶Child 2–5 months:Initially 150 micrograms/kg, then (by
intravenous injection) 100 micrograms/kg every
6 – 9 minutes as required, alternatively (by intravenous
infusion) 8 – 10 micrograms/kg/minute, (by intravenous
infusion) adjusted in steps of 1 microgram/kg/minute
every 3 minutes if required; (by intravenous infusion)
usual dose 11 – 14 micrograms/kg/minute814 Anaesthesia adjuvants BNFC 2018 – 2019
Anaesthesia15