阿曲庫銨
Atracurium Besylate
Atracurium besylate
別名: Tracrium · Abbottracurium · Faulcurium · Ifacur · Laurak · Mycurium · Relatrac · Sitrac · Trablok · 33A74 · atracurium besilate · BW-33A
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 | — | 🌎 NA |
| Neuromuscular blockade augmentation during corneal surgery | 0.15 mg/kg IV | IV | Single dose | — | 🌎 NA |
| Muscle relaxant to facilitate intubation in patients with severe blunt trauma | 0.25 mg/kg IV push | IV | Single dose | — | 🌎 NA |
| 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 3-9 micrograms/kg/min | IV | CRI | — | 🌎 NA |
- Critically ill patients when low concentrations of, or no inhalant anesthesia can be used: 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.
- Muscle relaxant to facilitate intubation in patients with severe blunt trauma: Given if patient requires intubation after IV acepromazine (0.01 mg/kg) + butorphanol (0.1 mg/kg) + ketamine (1 mg/kg).
- Induction of respiratory muscle paralysis during mechanical ventilation: Use D5W or 0.9% sodium chloride for diluent; do not mix with other drugs. Respiratory and cardiovascular monitoring should be provided.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Induction dose | 0.22 mg/kg IV | IV | Single dose | — | 🌎 NA |
| Intraoperative dose | 0.11 mg/kg IV | IV | As needed | — | 🌎 NA |
| 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 | — | 🌎 NA |
| 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 | — | 🌎 NA |
- Induction 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.
- Induction of respiratory muscle paralysis during mechanical ventilation: 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: Do not dose more frequently than every 20-30 minutes unless a peripheral nerve stimulator is applied. Positive pressure ventilation required.
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Paralysis for periophthalmic surgery (Rabbits) | 0.1 mg/kg | IV | Single dose | — | 🌎 NA |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Intraoperative dose | 0.055 mg/kg IV | IV | As needed | — | 🌎 NA |
- Intraoperative dose: Note: ARCI UCGFS Class 2 Drug. Atracurium is more potent in horses than in other species.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
阿曲庫銨是一種廣泛使用的非去極化神經肌肉阻斷劑，主要作為全身麻醉的輔助藥物。它能提供深度的骨骼肌鬆弛，以利於外科手術、氣管插管和機械通氣。
臨床關鍵要點：
- 非器官依賴性代謝： 阿曲庫銨透過霍夫曼消除（Hofmann elimination）和酯水解進行代謝，這使其對於患有嚴重肝腎疾病的病患極具價值。
- 無鎮痛或鎮靜作用： 它會使病患癱瘓，但絕對不提供任何止痛或失去意識的效果。絕不能作為單一藥物使用。
- 心血管穩定性： 在標準劑量下，與較舊的神經肌肉阻斷劑相比，其心血管副作用極小，儘管偶爾可能引發組織胺釋放。
- 物種敏感性： 該藥物在馬匹體內的效力明顯高於其他物種。
作用機轉
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).
安全性與警告
禁忌症
- Hypersensitivity to atracurium
- Relative contraindication: Myasthenia gravis
- Lack of ventilatory support (must have mechanical ventilation available)
不良反應
- Allergic reactions
- Inadequate or prolonged neuromuscular block
- Hypotension
- Vasodilation
- Bradycardia
- Tachycardia
- Dyspnea
- Bronchospasm
- Laryngospasm
- Rash
- Urticaria
- Injection site reaction
注意事項
CRITICAL WARNING: Atracurium has NO analgesic or sedative/anesthetic actions. Patients must be appropriately sedated/anesthetized and provided with analgesia.
- Ventilation: Positive pressure ventilation (preferably mechanical) is absolutely required when using this drug.
- Histamine Release: May rarely cause significant histamine release; use with caution in patients where this would be hazardous (e.g., severe cardiovascular disease, asthma).
- Myasthenia Gravis: Use with extreme caution, or not at all, in patients suffering from myasthenia gravis.
- Vagal Tone: Has minimal cardiac effects and will not counteract bradycardia or vagal stimulation induced by other anesthetic agents.
藥物交互作用
May enhance the neuromuscular blocking activity of atracurium
May enhance and prolong the neuromuscular blocking activity
May enhance neuromuscular blocking activity
May enhance neuromuscular blocking activity
May enhance neuromuscular blocking activity
May enhance neuromuscular blocking activity
May enhance neuromuscular blocking activity
Reported to decrease both the effects and duration of neuromuscular blockade
May cause a synergistic or antagonistic effect
May speed the onset of action and enhance the neuromuscular blocking actions of atracurium. Do not give atracurium until succinylcholine effects have diminished.
監測
- 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)
藥物動力學
吸收
After IV injection, maximal neuromuscular blockade generally occurs within 3-5 minutes. Duration of blockade generally persists for 20-35 minutes.
代謝
Metabolized by ester hydrolysis and Hofmann elimination that occur independently of renal or hepatic function. Physiologic pH and temperature can affect elimination (increased body temp enhances elimination; decreased pH enhances ester hydrolysis but reduces Hofmann elimination).
排除
Eliminated via Hofmann degradation and ester hydrolysis. Systemic alkalosis may diminish the degree and duration of blockade; acidosis potentiates it.
過量
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.
可用產品
劑型
- Injection
人用標示
- Atracurium Besylate Injection: 10 mg/mL in 5 mL single-use & 10 mL multiuse vials (Tracrium, generic)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store in the refrigerator (2-8°C) and protect against freezing. At room temperature, approximately 5% potency loss occurs each month; when refrigerated, a 6% potency loss occurs over a year's time. Incompatible when mixed with alkaline drugs (e.g., barbiturates, sodium bicarbonate), propofol, diazepam, thiopental, aminophylline, cefazolin, heparin, ranitidine, and sodium nitroprusside.
飼主須知
本藥物是一種高度專業的肌肉鬆弛劑，僅由獸醫專業人員在全身麻醉或重症加護機械通氣期間使用。
- 它能確保您的寵物在精細手術（如眼科手術）期間保持完全靜止，或在病危時幫助牠們配合呼吸機呼吸。
- 因為它僅能放鬆肌肉，並不提供止痛或睡眠效果，所以總是會與強效止痛藥和鎮靜劑或麻醉劑一起給予，以確保您的寵物完全失去意識且感到舒適。
VetSheet 藥物參考供合格獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠商最新仿單。