Atracurium Besylate

Indications

Atracurium Besylate is indicated as an adjunct to general anesthesia. It is employed to facilitate endotracheal intubation and ensure skeletal muscle relaxation during surgical procedures or mechanical ventilation.

Pharmacodynamics

Atracurium functions as a nondepolarizing skeletal muscle relaxant. Its effectiveness can be optimized by monitoring the muscle twitch response to peripheral nerve stimulation, which helps in assessing the extent of muscle relaxation. Compared to other neuromuscular blockers like d-tubocurarine, metocurine, and pancuronium, Atracurium provides a neuromuscular block with a duration approximately one-third to one-half shorter at equivalent doses. The onset of paralysis occurs more quickly and the duration of maximum effect lengthens with higher doses of Atracurium. Importantly, when maintenance doses are repeated, Atracurium does not exhibit cumulative effects on the neuromuscular blockade duration, assuming recovery is initiated before additional doses are administered. Consequently, recovery time remains consistent with repeated dosing, allowing for regular intervals of administration with predictable outcomes.

Mechanism of Action

Atracurium Besylate functions by competitively binding to cholinergic receptor sites on the motor end-plate, thereby antagonizing the action of the neurotransmitter acetylcholine. This binding process prevents acetylcholine from exerting its usual effect, resulting in neuromuscular blockade. However, this antagonism can be effectively counteracted and the neuromuscular block reversed through the administration of acetylcholinesterase inhibitors, including neostigmine, edrophonium, and pyridostigmine.