์ํธ๋ผ์ฟ ๋ฅจ ๋ฒ ์ค์ฐ์ผ
์ํธ๋ผ์ฟ ๋ฅจ์ ์ ์ ๋ง์ทจ์ ๋ณด์กฐ์ ๋ก ์ฃผ๋ก ์ฌ์ฉ๋๋ ๋๋ฆฌ ํ์ฉ๋๋ **๋นํ๋ถ๊ทน์ฑ ์ ๊ฒฝ๊ทผ ์ฐจ๋จ์ **์ ๋๋ค. ์ธ๊ณผ์ ์์ , ๊ธฐ๊ด ๋ด ์ฝ๊ด ๋ฐ ๊ธฐ๊ณ์ ํ๊ธฐ๋ฅผ ์ฉ์ดํ๊ฒ ํ๊ธฐ ์ํด ๊น์ ๊ณจ๊ฒฉ๊ทผ ์ด์์ ์ ๊ณตํฉ๋๋ค. **ํต์ฌ ์์ ์ ๋ณด:** * **์ฅ๊ธฐ ๋ ๋ฆฝ์ ๋ฐฐ์ถ:** ์ํธ๋ผ์ฟ ๋ฅจ์ ํธํ๋ง ์ ๊ฑฐ(Hofmann elimination) ๋ฐ ์์คํ ๋ฅด ๊ฐ์๋ถํด๋ฅผ ํตํด ๋์ฌ๋๋ฏ๋ก ์ฌ๊ฐํ ์ ์ฅ ๋๋ ๊ฐ ์งํ์ด ์๋ ํ์์๊ฒ ๋งค์ฐ ์ ์ฉํฉ๋๋ค. * **์งํต ๋๋ ์ง์ ํจ๊ณผ ์์:** ํ์๋ฅผ ๋ง๋น์ํค์ง๋ง ํต์ฆ ์ํ๋ ์์ ์์ค์ ์ ํ ์ ๊ณตํ์ง ์์ต๋๋ค. ์ ๋ ๋จ๋ ์ฝ๋ฌผ๋ก ์ฌ์ฉํด์๋ ์ ๋ฉ๋๋ค. * **์ฌํ๊ด๊ณ ์์ ์ฑ:** ํ์ค ์ฉ๋์์ ๊ธฐ์กด์ ์ ๊ฒฝ๊ทผ ์ฐจ๋จ์ ์ ๋นํด ์ฌํ๊ด๊ณ์ ๋ฏธ์น๋ ์ํฅ์ด ์ต์ํ๋์ง๋ง, ๊ฐํน ํ์คํ๋ฏผ ๋ฐฉ์ถ์ ์ ๋ฐํ ์ ์์ต๋๋ค. * **์ข ํน์ด์ ๋ฏผ๊ฐ์ฑ:** ์ด ์ฝ๋ฌผ์ ๋ค๋ฅธ ์ข ์ ๋นํด ๋ง์์ ํนํ ๋ ๊ฐ๋ ฅํ ํจ๋ฅ์ ๋ํ๋ ๋๋ค.
์์ฉ ๊ธฐ์ : 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 โ inhibits depolarization of the muscle cell membrane โ 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).
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Induction dose ยท 0.22 mg/kg IV ยท IV ยท Single dose ยท 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 ยท 0.11 mg/kg IV ยท IV ยท As needed
- Induction of respiratory muscle paralysis during mechanical ventilation ยท Loading dose: 0.2-0.5 mg/kg IV, then a constant rate infusion 5 minutes later of 0.37 micrograms/kg/min ยท IV ยท CRI ยท 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 ยท 0.2 mg/kg IV initial dose; subsequent doses 0.1 mg/kg IV ยท IV ยท every 20-30 minutes ยท Do not dose more frequently than every 20-30 minutes unless a peripheral nerve stimulator is applied. Positive pressure ventilation required.
- Intraoperative dose ยท 0.055 mg/kg IV ยท IV ยท As needed ยท Note: ARCI UCGFS Class 2 Drug. Atracurium is more potent in horses than in other species.
- Paralysis for periophthalmic surgery (Rabbits) ยท 0.1 mg/kg ยท IV ยท Single dose
- Critically ill patients when low concentrations of, or no inhalant anesthesia can be used ยท 0.2 mg/kg IV initial dose; subsequent doses 0.1 mg/kg IV ยท IV ยท every 20-30 minutes ยท 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.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to atracurium
- Relative contraindication: Myasthenia gravis
- Lack of ventilatory support (must have mechanical ventilation available)
์ด์๋ฐ์
- Allergic reactions
- Inadequate or prolonged neuromuscular block
- Hypotension
- Vasodilation
- Bradycardia
- Tachycardia
- Dyspnea
- Bronchospasm
- Laryngospasm
- Rash
- Urticaria
- Injection site reaction
์ฝ๋ฌผ ์ํธ์์ฉ
- Aminoglycoside antibiotics (e.g., gentamicin) ยท May enhance the neuromuscular blocking activity of atracurium
- General anesthetics (enflurane, isoflurane, halothane, sevoflurane) ยท May enhance and prolong the neuromuscular blocking activity
- Bacitracin, Polymyxin B (systemic) ยท May enhance neuromuscular blocking activity
- Procainamide ยท May enhance neuromuscular blocking activity
- Quinidine ยท May enhance neuromuscular blocking activity
- Lithium ยท May enhance neuromuscular blocking activity
- Magnesium salts ยท May enhance neuromuscular blocking activity
- Anticonvulsants (Phenytoin, Carbamazepine) ยท Reported to decrease both the effects and duration of neuromuscular blockade
- Other muscle relaxant drugs ยท May cause a synergistic or antagonistic effect
- Succinylcholine ยท May speed the onset of action and enhance the neuromuscular blocking actions of atracurium. Do not give atracurium until succinylcholine effects have diminished.
๋ชจ๋ํฐ๋ง
- 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)
๊ณผ์ฉ๋
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.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.