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

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300