Advice for the use of atracurium in anaesthesia
and intensive care
18 December 2020
The second surge in cases of COVID-19 has created increased demand for the non-depolarising neuromuscular blocking drug atracurium, and this drug is now subject to a supply disruption alert.
There are currently no other significant demand pressures reported for drugs used in anaesthesia and critical care.
Our advice to healthcare professionals working in anaesthesia and intensive care is:
use rocuronium instead of atracurium when possible. If an infusion of rocuronium is to be used, the British National Formulary (BNF) recommends that after an initial bolus to establish neuromuscular blockade, an infusion at the rate of 0.3 – 0.6 mg.kg-1.h-1 be given, adjusted according to response
only use atracurium when there is no alternative, e.g. allergy to rocuronium and related drugs, such as vecuronium, or significant renal impairment
cisatracurium can continue to be used when it is already the first-choice neuromuscular blocking drug but a marked increase in use is likely to lead to demand pressure
pancuronium and vecuronium are available and can be used when appropriate, assuming there are no contraindications to their use
This advice will be updated when the situation changes.
ENDS