Atracurio Use in Anesthesia

Mechanism of Action and Pharmacokinetics

• The American Society of Anesthesiologists acknowledges that atracurio is a non-depolarizing neuromuscular blocking agent of the benzylisoquinolinium group, acting by competitively binding to cholinergic receptors at the motor end plate 1, 2
• The atracurio is inactivated in the plasma through two mechanisms: ester hydrolysis and Hofmann elimination, which makes renal or hepatic dysfunction not affect the duration of the block 1, 2
• The laudanosine, a product of Hofmann elimination of atracurio, has been associated with central nervous system excitement at extremely high doses 2

Clinical Guidelines and Recommendations

• The American College of Cardiology recommends atracurio for laparotomy or laparoscopic abdominal surgery with a Grade 1+ recommendation 3
• For patients with renal or hepatic insufficiency, atracurio is likely recommended over other muscle relaxants due to its organ-independent elimination 3

Safety and Adverse Effects

• The atracurio may cause histamine release at higher doses, which can lead to adverse cardiovascular effects 1, 2