Although atracurium produces few direct circulatory effects the absence of vagal blocking activity makes the patient vulnerable to bradycardias during anaesthesia. The patient should be monitored closely and any bradycardias treated with atropine. Some anaesthetists give atropine or glycopyrrolate routinely at induction to prevent this problem. Histamine may also be released if atracurium precipitates in the syringe or vein. This may occur if atracurium is injected immediately after thiopentone.
Placental transfer is insignificant and the drug is widely used in obstetrics.
There is little change in its effects in patients with renal or liver failure. When used for long operations it is very predictable. Supplemental doses should be 5-10mg. Always flush the vein with saline if using the two drugs at induction. Storage should be in a refrigerator at 4 degrees centigrade as the drug deteriorates at room temperature.