A muscle relaxant for anaesthesia
Atracurium
An intermediate-acting muscle relaxant given by an anaesthetist that is broken down in the blood, helpful in kidney or liver problems.
What is Atracurium?
Atracurium is a muscle relaxant given only by an anaesthetist during a general anaesthetic. It temporarily paralyses the muscles, including the breathing muscles, so a breathing tube can be placed and the muscles stay still for surgery. You are always asleep first and a machine breathes for you throughout. A useful feature is that it is broken down in the blood itself, so it is often chosen for people whose kidneys or liver are not working well. It can cause flushing or wheeze in some people because it releases a natural substance called histamine.
Education and reference only. This is a plain-language guide to Atracurium — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Atracurium is a non-depolarising muscle relaxant used during general anaesthesia. It relaxes the muscles so the anaesthetist can place a breathing tube and keep the muscles still during surgery. It is intermediate-acting, and its main distinguishing feature is that it is broken down in the bloodstream by a natural chemical process (called Hofmann elimination) rather than relying on the kidneys or liver. It is given as an injection into a vein by an anaesthetist, only when you are asleep and your breathing is supported by a machine.
How it works
Atracurium acts at the junction between nerves and muscles, blocking the signal that makes muscles contract so they relax. What sets it apart is how it is cleared: it breaks down spontaneously in the blood at normal body temperature and acidity, so it does not depend on the kidneys or liver to wear off. This makes its duration fairly predictable even when those organs are not working well. The block is checked with a nerve monitor, and a machine breathes for you throughout.
Company & origin
Originated / developed by: Generic (long-established).
An intermediate-acting muscle relaxant used in the UK by anaesthetists, broken down in the blood so it is useful when the kidneys or liver are not working well.
Practical use
How to take Atracurium
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- This medicine is given only by an anaesthetist as an injection into a vein, never taken at home.
- You will always be fully asleep under general anaesthetic before it is given.
- A breathing tube is placed and a machine breathes for you while the muscles are relaxed.
- The anaesthetist monitors the block and lets it wear off or reverses it at the end of surgery.
- Tell your anaesthetist beforehand about asthma or any previous reaction to anaesthetics or muscle relaxants.
Weighing it up
Advantages & disadvantages of Atracurium
Advantages
- Broken down in the blood itself, so it is useful when the kidneys or liver are not working well.
- Has a fairly predictable, intermediate duration that does not rely on organ function.
- A well-established option that anaesthetists know and use widely.
Disadvantages
- Can release histamine, causing flushing, a drop in blood pressure or wheeze in some people.
- Like all muscle relaxants, it can rarely cause a severe allergic reaction.
- It must always be used with a breathing machine and close monitoring by an anaesthetist.
Practical use
Good to know
You are always fully asleep before atracurium is given, and a machine breathes for you the whole time, so you are never aware of being paralysed. Because atracurium is broken down in the blood itself, it is a helpful choice for people with kidney or liver failure, whose bodies may struggle to clear other relaxants. One thing to be aware of is that atracurium can release histamine, a natural body chemical, which may cause flushing of the skin, a drop in blood pressure or wheeze in some people; the anaesthetist manages this if it happens. The block is followed with a nerve monitor and can be reversed at the end. As with all these medicines, malignant hyperthermia and severe allergy are the key emergencies the team watches for.
Who should not take it / use with caution
- People who have had a severe allergic reaction to atracurium or similar muscle relaxants should not be given it.
- It is used with care in people prone to wheeze, such as some people with asthma, because of histamine release.
- Any decision is made by the anaesthetist after reviewing your health and previous anaesthetics.
Monitoring
- Continuous monitoring of breathing, oxygen, heart rate and blood pressure throughout.
- A nerve monitor is used to check the depth and recovery of muscle relaxation.
- The team watches for flushing, wheeze or any sign of a severe allergic reaction.
Side effects
- Flushing of the skin or a temporary drop in blood pressure from histamine release.
- Wheeze in some people, particularly those prone to it.
- Rarely, a severe allergic reaction, which the team is trained to treat immediately.
Key interactions
- Some antibiotics and other anaesthetic drugs can lengthen or change its effect.
- A reversal medicine can be used at the end to help the block wear off.
- The anaesthetist manages all interactions directly in the operating theatre.
Available as: Injection into a vein, given only by an anaesthetist in hospital.
Answers
Atracurium: frequently asked questions
Will I be aware while my muscles are relaxed?
No. You are always fully asleep under general anaesthetic before atracurium is given, and a machine breathes for you, so you are not aware of being paralysed.
Why might atracurium be chosen for me?
It is broken down in the blood itself rather than by the kidneys or liver, so it is often a good choice for people whose kidneys or liver are not working well.
Why did my skin flush or feel warm?
Atracurium can release histamine, a natural body chemical, which may cause flushing, a drop in blood pressure or wheeze; the anaesthetist watches for and manages this.
How is it reversed?
At the end of surgery the block wears off as the drug breaks down in the blood, and a reversal medicine can be used to help; recovery is checked before the tube is removed.
Is it safe if I have asthma?
It can cause wheeze in people prone to it because of histamine release, so tell your anaesthetist about asthma; they will take this into account when choosing a relaxant.
Authoritative sources
- BNF
- NICE CKS
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