Atracurio Pharmacokinetics and Clinical Use
Mechanism of Action and Pharmacokinetics
- The American Society of Anesthesiologists acknowledges that atracurio is a non-depolarizing neuromuscular blocker of the benzylisoquinolinium group that acts by competitively binding to cholinergic receptors at the motor end plate 1
- Atracurio is inactivated in the plasma through two independent mechanisms that do not rely on renal or hepatic function: hydrolysis by esterases and Hofmann elimination 2
Clinical Guidelines and Precautions
- The American College of Clinical Pharmacology recommends the use of a peripheral nerve stimulator to allow for the most advantageous use of atracurio, minimizing the possibility of overdose or underdose, and aiding in the assessment of recovery 5
- High doses of atracurio may be associated with histamine release, potentially causing adverse cardiovascular effects, as noted by the American Heart Association 5, 1
- The laudanosine, a product of Hofmann elimination of atracurio, has been associated with central nervous system excitement at extremely high doses, according to the American Society of Anesthesiologists 2, 5, 1