Tubocurarine chloride U.S.P.

Category:

  • Muscle relaxant

  Description:

  • Curare class, nondepolarizing skeletal muscle relaxant

  Indications:

  • Adjunct to general anesthesia to facilitate intubation and skeletal muscle relaxation

  • Diagnostic agent for myasthenia gravis

  Contraindications:

  • Patients in whom histamine release if a definite hazard.

  Precautions:

  • Pregnancy category C

  • Only used by skilled personnel in airway management and respiratory support.

  • Must have anticholinesterase reversal agents immediately available during use.

  • Will cause histamine release.  Use with caution in patients susceptible to histamine, such as cardiovascular disease and asthma.

  • May cause bradycardia during anesthesia.

  • Use with caution in patients with neuromuscular disease.

  • Use in caution in elderly due to increased dosage requirements and recovery times.

  • Does not alter consciousness or relieve pain.

  • Use a peripheral nerve stimulator to monitor twitch suppression and recovery.

  • IM injection may cause tissue irritation.

Adverse Reactions (Side Effects):

  • Cardiovascular: arrhythmias, cardiac arrest, bradycardia, hypotension

  • Excessive salivation

  • Prolonged respiratory suppression

Dosage:

  • Administered IV as a sustained injection over 1-1.5 minutes or IM

  • Individualize dosage calcualted at 0.1-0.2mg/kg

  • General dosing reference:

    • Adult (70kg): 40-60 units IV at time of incision, 20-30 units in 3-5 minutes if required

    • long operations: supplemental doses of 20 units as required (based on 1.1 units/kg)

    • Electroshock therapy (EST): 1.1 units/kg

    • Myasthenia gravis diagnosis:

    • administer 1/15 to 1/5 of EST dose

    • exaggerated response will occur

    • reverse effect with neostigmine

  • Children: 0.6mg/kg

  • Neonates: 0.3mg/kg

 
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