Tsisatrakuriya besilate

When ATH:
M03AC11

Characteristic.

Synthetic materials, one of 10 isomers of atracurium besylate. Molecular weight 1243,51; the solution has a pH of 3.25-3.65.

Pharmacological action.
N-holinolitičeskoe, miorelaksiruyuschee, nedepoliarizuth.

Application.

Muscle relaxation during surgery, intubation, mechanical ventilation.

Contraindications.

Hypersensitivity, incl. other derivative benzilhinolinovym (incl. atracurium, myvakuryy).

Restrictions apply.

Violation of the acid-base balance and electrolyte balance, burns, karцinomatoz, neuromuscular diseases (incl. myasthenia, myasthenic syndrome) or other conditions, which can lead to prolonged neuromuscular blockade, gemiparez, paraparesis, Age to 2 years (not enough clinical experience).

Pregnancy and breast-feeding.

During pregnancy and breast-feeding use only possible, if the effect of the application of more than the potential harm to the fetus and child. There are no adequate and well-controlled studies in pregnant women have not held, information on the penetration of breast milk is not available.

Animal studies revealed no embryotoxic and teratogenic effects subparaliticheskih (4 mg / kg p /) and paralytic (0,5-1 Mg / kg / in) doses.

Category actions result in FDA - B. (The study of reproduction in animals revealed no risk of adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not done.)

Side effects.

Allergic reactions (including anaphylaxis), rash (0,1%), muscular weakness, myopathy, bradycardia (0,4%), gipotenziya (0,2%), flushing (0,2%), bronchospasm (0,2%).

Cooperation.

Chemically unstable when diluted in Ringer's lactate solution, incompatible with alkaline solutions, for example thiopental sodium. The effect of increasing the means for inhalation anesthesia (halothane, diethyl ether, enfluran, izofluran), Other non-depolarizing muscle relaxants, antibiotics (aminoglikozidy, Polymyxin, spectinomycin, tetracikliny, lincomycin and clindamycin); antiarrhythmics (propranolol, lidokain, prokaynamyd, quinidine), Diuretic (furosemid, tiazidы), magnesium salts, lithium, ganglioblokatorы (hexamethonium et al.), Local anesthetics. It weakens the effect of previous long-term use of phenytoin or carbamazepine. Preliminary administration of suxamethonium has no effect on the duration of neuromuscular block. Introduction suksametonia to increase the duration of neuromuscular block, caused by non-depolarizing muscle relaxants, It can lead to a long and complex blockade, which it can be difficult to remove using anticholinesterases. Incompatible with ketorolac, trimetamolom, propofol.

Overdose.

Symptoms: lengthening of muscle relaxation.

Treatment: maintain adequate ventilation to restore adequate neuromuscular; specific therapy: anticholinesterase agents (neostigmine 0.04-0.07 mg / kg) administered only after the onset of spontaneous recovery simultaneously with anticholinergics (atropynom). Antagonists (neostigmine and others.) It should not be used in full neuromuscular block (Confirm the restoration is recommended peripheral neurostimulation). It is necessary to conduct a full recovery ventilator to breath.

Dosing and Administration.

B /, bolus. Adults: the initial dose (for intubation) / in 0.15-0.2 mg / kg, fast, for 5-10 s. Maintenance doses to prolong muscle relaxation: in surgery on / in 0,03 mg / kg at intervals of about 20 m, continuous or on / in Infusion 0,003 mg / kg / min (the initial dose) with decreased to 0.001-0.002 mg / kg / min; less frequent or smaller maintenance doses used in patients, located on inhalation anesthesia (enfluran, izofluran), infusion rate is reduced by 30-40%. In intensive care: 0,003 mg / kg / min with further dose adjustments if necessary (0,0005-0.0101 Mg / kg / min).

Children over 2 years: the initial dose - 0,1 mg / kg / in for 5-10 seconds; maintenance doses: при оперативных вмешательствах — в/в инфузия 0,003 mg / kg / min, followed by reduction of the dose to be 0.001-0.002 mg / kg / min; при интенсивной терапии — 0,003 mg / kg / min, possible dose adjustment.

Dose adjustment in elderly patients, patients with impaired renal function, liver, diseases of the cardiovascular system is not required.

Precautions.

Before the restoration of adequate spontaneous respiration is necessary to maintain ventilation and oxygenation of the blood. If signs of spontaneous recovery of neuromuscular, it can be accelerated by administration of anticholinesterases.

It causes respiratory paralysis and other skeletal muscle, but it has no effect on consciousness or pain threshold. It should be administered only anesthesiologist or technician, with experience in the use of muscle relaxants, ensuring the possibility of intubation, Adequate ventilation and oxygenation of the blood.

As one of the substances with an average time of action, not recommended for use for emergency intubation. It is recommended that monitoring of neuromuscular conduction using peripheral nerve stimulation; Additional doses should not be introduced until, until a valid response to neurostimulation; if the response is not caused, administration should be suspended until the beginning of the restoration of neuromuscular conduction.

It may have a more pronounced and prolonged effect in patients with neuromuscular diseases (as myasthenia gravis, myasthenic syndrome), when kantseromatoze; in these cases, it is not suitable for use higher doses 0,02 mg / kg.

May reduce the effectiveness tsisatrakuriya patients with burns, gems- and paraparesis (in the affected limb).

Patients with renal and hepatic: clinically significant differences profiles no recovery. In patients with end-stage liver disease the initial effect is to 1 minutes later, а при нарушении функции почек — на 1 minutes longer.

It should be taken into account, that children 2-12 years of effective doses below, the initial effect is faster, duration of action and recovery time of neuromuscular transmission less, than in adults.

Cooperation