Indications

• Need for Procedural/Operative Paralysis
• Need for Sedation to Facilitate Mechanical Ventilation in Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])
• Rapid Sequence Intubation (RSI) (see Airway Management, [[Airway Management]])

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Pharmacology

• Benzylisoquinolinium Neuromuscular Junction Antagonist (see Neuromuscular Junction Antagonists, [[Neuromuscular Junction Antagonists]])

Metabolism

• xxxx

-Metabolism: non-enzymatic Hoffman rxn + ester hydrolysis in plasma (does not depend on renal or hepatic metabolism)
– Burn patients may show resistance to NMJ blockers

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Administration

• Load (IV): 0.4-0.5 mg/kg

  • Onset of Action: 110 sec
  • Duration of Action: 43 min

• Maintenance (IV): 4-20 µg/kg/min

Dose Adjustment

• Hepatic:
• Renal:

Drug Interactions

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-Drug Interactions (all enhance Atra effect): lithium, aminoglycosides, polymyxins, magnesium, quinidine, procainamide

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Adverse Effects

*Absence of Vagolytic Effect
*May Cause Histamine Release -> Bronchospasm/Hypotension

-SE: histamine release (hypotension, wheezing)/minimal ganglionic block/prolonged NMJ block (rare)
– No reports of vagal block tachycardia

Other Adverse Effects

• xxx
• xxx
• xxx

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References

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