Atracurium Dose in Paediatric Patients

• 0.5 mg/kg IV (range 0.25-0.5 mg/kg) - produces good intubating conditions in roughly 90-180 seconds
• Same dose is used across infants, children, and adults - atracurium is notable among nondepolarizing NMBDs because dosing does not need to be adjusted for age. In children older than 2 years, dose and duration are essentially the same as in adults (Goodman & Gilman's, p. 676)

• Incremental/top-up doses of 0.1 mg/kg every 10-20 minutes as needed for ongoing relaxation
• Continuous infusion: 5-10 mcg/kg/min can be used instead of intermittent boluses (Morgan and Mikhail's Clinical Anesthesiology, p. 396)

• Onset of neuromuscular block is faster in infants (~30%) and children (~40%) compared with adults, likely due to circulatory factors (lower cardiac output, faster circulation time)
• Volume of distribution is increased in infants, but clearance is also more rapid - these offset each other, so duration of action is not significantly different from adults
• Recovery is little affected by age in infants older than 1 month
• Histamine release and related adverse reactions (flushing, hypotension, tachycardia, bronchospasm) occur less frequently in children than in adults, though histamine release remains dose-dependent and becomes significant above 0.5 mg/kg
• Atracurium's elimination (Hofmann elimination + ester hydrolysis) is independent of renal and hepatic function, making it a useful choice in children with organ dysfunction