아트라쿠륨 베실산염

비탈분극성 신경근 차단제

아트라쿠륨은 전신 마취의 보조제로 주로 사용되는 널리 활용되는 **비탈분극성 신경근 차단제**입니다. 외과적 수술, 기관 내 삽관 및 기계적 환기를 용이하게 하기 위해 깊은 골격근 이완을 제공합니다. **핵심 임상 정보:** * **장기 독립적 배출:** 아트라쿠륨은 호프만 제거(Hofmann elimination) 및 에스테르 가수분해를 통해 대사되므로 심각한 신장 또는 간 질환이 있는 환자에게 매우 유용합니다. * **진통 또는 진정 효과 없음:** 환자를 마비시키지만 통증 완화나 의식 소실을 전혀 제공하지 않습니다. 절대 단독 약물로 사용해서는 안 됩니다. * **심혈관계 안정성:** 표준 용량에서 기존의 신경근 차단제에 비해 심혈관계에 미치는 영향이 최소화되지만, 간혹 히스타민 방출을 유발할 수 있습니다. * **종 특이적 민감성:** 이 약물은 다른 종에 비해 말에서 특히 더 강력한 효능을 나타냅니다.

작용 기전: Atracurium acts by competitively binding to **nicotinic cholinergic receptors** at the motor end-plate of the neuromuscular junction. By occupying these receptors, it prevents **acetylcholine (ACh)** from binding → inhibits depolarization of the muscle cell membrane → results in flaccid paralysis of skeletal muscles. Because it is a competitive antagonist, its effects can be reversed by increasing the concentration of ACh at the neuromuscular junction (e.g., by administering acetylcholinesterase inhibitors like neostigmine or edrophonium).

동물 종별 용량

Cats

Induction dose · 0.22 mg/kg IV · IV · Single dose · Give 1/10th to 1/6th of this dose initially as a 'priming' dose, followed 4-6 minutes later with the remainder and a sedative/hypnotic agent.
Intraoperative dose · 0.11 mg/kg IV · IV · As needed
Induction of respiratory muscle paralysis during mechanical ventilation · Loading dose: 0.2-0.5 mg/kg IV, then a constant rate infusion 5 minutes later of 0.37 micrograms/kg/min · IV · CRI · Use D5W or 0.9% sodium chloride for diluent; do not mix with other drugs.
Critically ill patients when low concentrations of, or no inhalant anesthesia can be used · 0.2 mg/kg IV initial dose; subsequent doses 0.1 mg/kg IV · IV · every 20-30 minutes · Do not dose more frequently than every 20-30 minutes unless a peripheral nerve stimulator is applied. Positive pressure ventilation required.

Horses

Intraoperative dose · 0.055 mg/kg IV · IV · As needed · Note: ARCI UCGFS Class 2 Drug. Atracurium is more potent in horses than in other species.

SmallMammals

Paralysis for periophthalmic surgery (Rabbits) · 0.1 mg/kg · IV · Single dose

Dogs

Critically ill patients when low concentrations of, or no inhalant anesthesia can be used · 0.2 mg/kg IV initial dose; subsequent doses 0.1 mg/kg IV · IV · every 20-30 minutes · Do not dose more frequently than every 20-30 minutes unless a peripheral nerve stimulator is applied, or voluntary movement is observed. Positive pressure ventilation required.

투여 경로

금기

Hypersensitivity to atracurium
Relative contraindication: Myasthenia gravis
Lack of ventilatory support (must have mechanical ventilation available)

이상반응

Allergic reactions
Inadequate or prolonged neuromuscular block
Hypotension
Vasodilation
Bradycardia
Tachycardia
Dyspnea
Bronchospasm
Laryngospasm
Rash
Urticaria
Injection site reaction

약물 상호작용

Aminoglycoside antibiotics (e.g., gentamicin) · May enhance the neuromuscular blocking activity of atracurium
General anesthetics (enflurane, isoflurane, halothane, sevoflurane) · May enhance and prolong the neuromuscular blocking activity
Bacitracin, Polymyxin B (systemic) · May enhance neuromuscular blocking activity
Procainamide · May enhance neuromuscular blocking activity
Quinidine · May enhance neuromuscular blocking activity
Lithium · May enhance neuromuscular blocking activity
Magnesium salts · May enhance neuromuscular blocking activity
Anticonvulsants (Phenytoin, Carbamazepine) · Reported to decrease both the effects and duration of neuromuscular blockade
Other muscle relaxant drugs · May cause a synergistic or antagonistic effect
Succinylcholine · May speed the onset of action and enhance the neuromuscular blocking actions of atracurium. Do not give atracurium until succinylcholine effects have diminished.

모니터링

Level of neuromuscular blockade (recommend use of a peripheral nerve stimulator to evaluate 'train of 4' twitches)
Spontaneous ventilation and voluntary muscle movement (if nerve stimulator is unavailable)
Cardiac rate and blood pressure
Core body temperature and acid-base status (can affect drug metabolism)

과용량

Overdosage increases the risks of **hypotension**, **histamine release**, and **prolonged duration of muscle blockade**. Overdose possibilities can be minimized by monitoring muscle twitch responses to peripheral nerve stimulation. **Treatment:** * Treat conservatively with mechanical ventilation, oxygen, and IV fluids. * **Reversal of blockade:** May be accomplished by administering an anticholinesterase agent such as **edrophonium** (0.5 mg/kg IV) or **neostigmine** (0.02-0.04 mg/kg IV) combined with an anticholinergic (**atropine** or **glycopyrrolate**) to prevent severe bradycardia. * Reversal is usually complete within 8-10 minutes. Because the duration of action of atracurium may be longer than the reversal agent, careful observation is required, and readministration of the reversal agent may be necessary.

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