Atrakuriya besilate

When ATH:
M03AC04

Characteristic.

Synthetic bischetvertichnoe ammonium compound, derivative benzilizohinolina, a mixture of 10 stereoisomers (in nonequivalent relations). Molecular weight - 1243,49. Solution - pyrogen-free, Transparent pale yellow liquid with a pH of 3.25-3.65.

Pharmacological action.
N-holinolitičeskoe, miorelaksiruyuschee, nedepoliarizuth.

Application.

Relaxed muscles during surgery, endotracheal intubation, IVL (as an adjunct to anesthesia).

Contraindications.

Hypersensitivity, incl. to mivacurium chloride and other muscle relaxants - benzylisoquinoline derivatives; myasthenia.

Restrictions apply.

Gipotenziya, gipotermiя; severe electrolyte imbalance, incl. hypocalcemia and hypokalemia; Acidosis; karцinomatoz; pediatric practice - children under the age of 1 Months, premature babies.

Pregnancy and breast-feeding.

Maybe, if the effect of the application exceeds the potential risk to the fetus and newborn.

Category actions result in FDA - C. (The study of reproduction in animals has revealed adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not held, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk.)

Side effects.

Allergic reactions: caused by the release of histamine - skin hyperemia due to vasodilation (5%), erythematous rash (0,5%), hives, itch (0,2%), bronchospasm, bronchial hypersecretion (0,2%), laringospazm, anaphylactoid reactions.

Cardio-vascular system and blood (hematopoiesis, hemostasis): Transient hypertension (2,1%) or hypotension (1,9%), tachycardia (2,1%) or bradycardia (0,6%), up to heart failure.

Other: breathlessness, an inadequate dose of the strength or duration of the blockade of neuromuscular transmission, rarely convulsions (amid ICU head trauma, brain edema, hypoxic encephalopathy, viral encephalitis, uremia).

Cooperation.

Strengthen and prolong the effects of inhaled general anesthetics: diethyl ether, halothane (on 20%), isoflurane and enflurane (on 35%), ketamine, benzogeksony, chlorpromazine, propranolol, certain antibiotics (aminoglikozidy, tetracikliny, Polymyxin, lincomycin, klindamiцin, spectinomycin), magnesium salts, including sulfate (when administered parenterally), prokaynamyd, quinidine, lidocaine and other antiarrhythmics, Diuretic (thiazide, furosemid, mannyt, aцetazolamid), lithium preparations (prolonged administration). It increases the risk of bradycardia and / or hypotension in the background of narcotic analgesics. It causes allergic cross-reaction with tubokurarinom and other muscle relaxants, promotes the release of histamine. Pharmaceutical incompatible (can not be mixed in the same syringe and inject / O at the same time) barbiturates, including thiopental sodium, alkaline solutions and products (you can change the acidic pH of the solution atrakuriya, its inactivation or precipitation of free acid).

Overdose.

Symptoms: prolonged respiratory depression or apnea, gipotenziya, collapse, prolonged paralysis (type myoplehyy), shock.

Treatment: administration of antagonists - anticholinesterase drugs, preferably neostigmine methyl sulfate, at a dose of 1–3 mg IV 0.5–2 min after preliminary IV administration of 0.25–0.7 mg atropine (to prevent adverse effects of m-cholinomimetic), for apnea and prolonged paralysis - mechanical ventilation until breathing is completely restored; with severe hypotension or shock - vasoconstrictors. Re-examination is required in 1 h after relief of neuromuscular blockade to exclude muscle relaxation.

Dosing and Administration.

B /. Doses set individually depending on the desired length and depth of neuromuscular blockade. Adults and children over 2 years - 0.3–0.6 mg/kg bolus, further 0.1–0.2 mg/kg fractionally or continuously infused at a rate of 0.3–0.6 mg/kg/h (doses are reduced by 20% against the background of halothane and 30% against the background of enflurane or isoflurane). With endotracheal intubation: Conventional mode - first 0.4-0.5 mg/kg, Then 0.25-0.35 mg/kg (possible 0.5–0.6 mg/kg during 90 from). For histamine hypersensitivity - 0.3–0.4 mg/kg slowly or in divided doses over 1 m. Children from 1 Months before 2 years - 0.3–0.4 mg/kg with halothane.

Against the background of induced hypothermia, maintenance doses are reduced by 50%. For patients with burns - increase the dose (resistance possible) depending on area and age (duration of existence) burns. Elderly patients - minimum recommended doses with a low rate of administration.

Precautions.

Extreme caution is necessary in patients with impaired neuromuscular transmission. Use only in the presence of antagonists and appropriate means for tracheal intubation and mechanical ventilation equipment. Relief of neuromuscular blockade with anticholinesterase drugs occurs no earlier than 8–35 minutes.

Cautions.

The solution slowly loses activity (approximately 6% in year) under storage conditions at 5 °C. About 5% activity is lost during 1 months at temperature 25 °C (It may be used, if kept at room temperature constantly, but not more 14 days), don't freeze. It should be taken into account, that the solution contains 0,9% benzyl alcohol (as a preservative). If fragmentation and/or color change occurs, the solution is not suitable for administration..