Delving into the Latest Updates on Atracurium Besylate with Synapse

Overview

Basic Info

Drug Type

Chemical drugs

Synonyms

Atracurium besilate, Atracurium besilate (INN), Atracurium besylate (USP)

+ [8]

Target

CHRNA2

Action

inhibitors

Mechanism

CHRNA2 inhibitors(cholinergic receptor nicotinic alpha 2 subunit inhibitors)

Therapeutic Areas

Other Diseases

Active Indication

Anesthesia

Inactive Indication

Muscle Hypotonia

Originator Organization

Hospira, Inc.

Active Organization

Jiangsu Hengrui Pharmaceuticals Co., Ltd.

Inactive Organization

Hospira, Inc.

License Organization-

Drug Highest PhaseApproved

First Approval Date

United States (23 Nov 1983),

Muscle Hypotonia

Regulation-

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Structure/Sequence

Molecular FormulaC59H77N2O15S

InChIKeyGLLXELVDCIFBPA-UHFFFAOYSA-M

CAS Registry64228-81-5

Diagnosis of perioperative anaphylaxis (POA) and identification of causative agents remain challenging. This study aimed to describe the estimated incidence, characteristics and causative agents of POA in Malaysia. This is a retrospective review of all cases of suspected POA referred to the only anaesthetic allergy centre in Malaysia from March 2014 to December 2022. One hundred and ninety patients with suspected POA of Grade 2 and above were included. Data on clinical presentation, severity, management, serum tryptase and subsequent allergy workup (including skin and serum testing results) of these patients were extracted from the database. Dynamic tryptase was elevated in half of the cases where tryptase results were available and skin tests were positive in 96% of these cases. Skin testing was positive in 113 patients (60%) overall, and more than 70% of Grades 3 and 4 anaphylaxis cases. Neuromuscular blocking agents (NMBAs) and antibiotics were the most commonly identified causative agents (27.4% and 23% respectively). The commonest NMBAs were rocuronium and atracurium, both commonly cross-reacting with cisatracurium. The overall cross-reactivity rate among NMBAs was 58%. For antibiotics, the commonest causative agents were cefuroxime, ceftriaxone and amoxicillin/clavulanic acid. Using these data, the estimated incidence of Grades 2–4 POA over this period in Malaysia was approximately 1 in 30,000 anaesthetics. However, owing to the voluntary nature of reporting, it is possible that this is an underestimate, particularly in relation to some milder Grade 2 cases which may have gone unrecognised or unreported.

01 Mar 2025·American Journal of Forensic Medicine & Pathology

Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature

Review

Author: Galoria, Darshan ; Shukla, Srushti ; Datta, Arijit ; Tiwari, Preeti ; Das, Abhishek ; Rana, Pradip ; Goswami, Dhara

AbstractAtracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

01 Mar 2025·Revista Española de Anestesiología y Reanimación (English Edition)

Anaesthesia evaluation and perioperative strategies in liver disease patients with cardiohepatic syndrome

Review

Author: Malvido, A ; Jain, M ; Espinosa, Á ; Ripolles Melchor, J ; Abad Gurumeta, A ; Navarro-Perez, R ; Shadad, Y A ; Alharbi, R

Cardiohepatic syndrome (CHS) presents a significant challenge in perioperative management due to the complex interaction between liver and heart dysfunction. CHS, analogous to cardiorenal syndrome, encompasses various conditions where hepatic and cardiovascular pathologies exacerbate one another. Patients with chronic liver disease, cirrhosis, or heart failure often exhibit increased perioperative morbidity and mortality, necessitating tailored anesthetic strategies. A comprehensive understanding of CHS pathophysiology is crucial, as it informs risk assessment and guides perioperative management. Risk stratification tools such as the Child-Pugh and MELD scores are commonly used, but they have limitations in fully capturing perioperative risks. The updated STS 2024 model includes liver-specific parameters, improving risk prediction in cardiac surgeries. Additionally, the VOCAL-Penn score addresses gaps in traditional risk models, providing a more accurate assessment for patients with advanced liver disease. Perioperative management focuses on minimizing hemodynamic stress and avoiding drugs metabolized by the liver. Agents like Remifentanil, Atracurium, and Esmolol are preferred for their minimal hepatic metabolism. Vasopressors such as terlipressin and vasopressin, which target the splanchnic circulation, improve hemodynamics in these patients. Within the Enhanced Recovery After Surgery (ERAS) framework, optimizing nutrition and fluid management is essential for reducing perioperative complications. Effective management of patients with CHS requires a multidisciplinary approach that integrates comprehensive risk assessment and individualized anesthetic strategies. This approach improves outcomes by reducing perioperative complications and mortality in this high-risk population.

100 Deals associated with Atracurium Besylate

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External Link

KEGG	Wiki	ATC	Drug Bank
D00758	Atracurium Besylate	M03AC04	DB00732

R&D Status

10 top approved records.

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Indication	Country/Location	Organization	Date
Anesthesia	China	Jiangsu Hengrui Pharmaceuticals Co., Ltd.	01 Jan 1997

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Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


Pubmed \| Anesthesiology	Not Applicable	Reversal of Neuromuscular Blockade	-	Atracurium 0.5 mg/kg	xoyyfwpltm(ikuzonaytn) = rhhyuthcxp yyjdtozysc (krebfmgiec ) View more	-	01 Mar 1995
				Vecuronium 0.1 mg/kg	xoyyfwpltm(ikuzonaytn) = fhyisbuhxh yyjdtozysc (krebfmgiec ) View more