Neuromuscular blockade

Atracurium 250mg/25ml should be used in ICU only.

Dose as per specialist.

Seek expert advice and see BNF.

Prescribing Notes:

Repeated suxamethonium doses can cause intense bradycardia or cardiac arrest and patients should be pretreated with an anticholinergic agent.
Suxamethonium is a depolarising agent causing rapid paralysis. Prolonged paralysis occurs in 1:2400 patients following administration of suxamethonium, as a genetically transmitted defect of metabolism.
Suxamethonium can trigger malignant hyperthermia.
Suxamethonium should be used with caution in patients with high potassium levels, such as in renal failure or burns.

27/10/2022

East Region Formulary content agreed.

Dose as per specialist.

Neostigmine is used for reversal of neuromuscular blocking agents. It requires concurrent antimuscarinic administration to prevent serious bradycardia or cardiac arrest. See Anaesthesia adjuvants pathway.
- Sugammadex is approved for restricted use for the reversal of neuromuscular blockade induced by rocuronium or vecuronium in adults and rocuronium in children and adolescents where prompt reversal of neuromuscular block is required.
- Note: Only the 2ml vials of sugammadex should be used routinely. The 5ml vials should only be used when emergency reversal is required.

27/10/2022

East Region Formulary content agreed.