Suspected toxicity of atracurium in the neonate

Use of premedication for intubation in tertiary neonatal units in the United Kingdom

“…Atracurium was preferred in 16% of units surveyed. However, a report from one UK center described four serious adverse reactions in neonates following atracurium premedication prior to intubation (21).…”

Neonatal tracheal intubation: an imbroglio unresolved

“…Atracurium and mivacurium have a slower onset of paralysis but a more rapid offset than rocuronium, which offer some advantages in neonates (11,15). However, severe low cardiac output has been reported in six neonates who received 0.5 mg·kg −1 atracurium (three of whom subsequently died) (22). The etiology of the low cardiac output was never established, although hypotension has been reported after atracurium.…”

Author's reply

“…Neonatal atracurium toxicity may be explained by atracurium moieties SIR -We were interested to read the recent letter by Clarkson et al reporting six cases of suspected toxicity of atracurium in neonates(1).Potential atracurium toxicity was first demonstrated in vitro byNigrovic et al in 1987 …”