What is the appropriate dosage of atracurium (a non-depolarizing neuromuscular blocker) for a patient weighing 30 kilograms requiring infusion for intubation?

Atracurium Dosing for a 30 kg Patient Requiring Infusion for Intubation

For a 30 kg patient requiring atracurium infusion for intubation, the appropriate dosage is 0.3-0.5 mg/kg, which equals 9-15 mg as an initial bolus dose, followed by maintenance doses of 0.08-0.10 mg/kg (2.4-3 mg) as needed.

Initial Dosing for Intubation

• For pediatric patients weighing 30 kg, the FDA-approved dosing of atracurium for intubation is 0.3-0.5 mg/kg given as an intravenous bolus injection 1
• For children 2 years or older, no dosage adjustments are required compared to adults, maintaining the 0.4-0.5 mg/kg standard dose 1
• For infants (1 month to 2 years of age) under halothane anesthesia, a slightly lower dose of 0.3-0.4 mg/kg is recommended as the initial dose 1
• With the recommended initial dose, good to excellent conditions for non-emergency intubation can be expected within 2-2.5 minutes in most patients 1

Maintenance Dosing

• Maintenance doses of 0.08-0.10 mg/kg (2.4-3 mg for a 30 kg patient) are recommended during prolonged procedures 1
• The first maintenance dose will generally be required 20-45 minutes after the initial injection 1
• Maintenance doses may be required with slightly greater frequency in infants and children than in adults 1
• Under balanced anesthesia, maintenance doses may be administered at intervals ranging approximately from 15 to 25 minutes 1

Special Considerations

• For patients with significant cardiovascular disease, a reduced initial dose of 0.3-0.4 mg/kg given slowly or in divided doses over one minute is recommended 1
• Atracurium is potentiated by isoflurane or enflurane anesthesia, requiring dose reduction by approximately one-third (to 0.25-0.35 mg/kg) if administered under steady-state of these inhalation agents 1
• With halothane, which has only a marginal (approximately 20%) potentiating effect on atracurium, smaller dosage reductions may be considered 1

Monitoring Recommendations

• A peripheral nerve stimulator should be used to optimize atracurium dosing, minimize the possibility of overdose, and help evaluate recovery 2
• Train-of-four (TOF) monitoring is the most reliable method for evaluating the degree of neuromuscular blockade 2
• Maximum neuromuscular block is achieved approximately 3-5 minutes after injection 1
• Under balanced anesthesia, recovery to 25% of control is achieved approximately 35-45 minutes after injection, and recovery is usually 95% complete approximately 60 minutes after injection 1

Important Precautions

• Atracurium should not be administered before unconsciousness has been induced 1
• It should not be mixed in the same syringe or administered simultaneously through the same needle with alkaline solutions (e.g., barbiturate solutions) 1
• Atracurium should be administered intravenously only, NOT by intramuscular administration 1
• High doses may be associated with histamine release, potentially causing adverse cardiovascular effects 3

By following these dosing guidelines and monitoring recommendations, atracurium can be safely and effectively administered to a 30 kg patient requiring neuromuscular blockade for intubation and mechanical ventilation.