Atracurium is a non-depolarizing neuromuscular blocking agent belonging to the benzylisoquinolinium class, used in anesthesia to produce skeletal muscle relaxation, facilitate endotracheal intubation, and assist mechanical ventilation during surgical and critical care procedures. It works by competitively blocking nicotinic acetylcholine receptors at the neuromuscular junction, thereby preventing muscle contraction and causing reversible paralysis. Atracurium was developed in the 1970s as part of efforts to create safer muscle relaxants with intermediate duration and predictable action compared to earlier drugs like d-tubocurarine. It was introduced into clinical practice in the early 1980s and became notable for its unique organ-independent metabolism through Hofmann elimination and ester hydrolysis, making it suitable for patients with liver or kidney impairment. Although associated with histamine release and the formation of the metabolite laudanosine, atracurium represented a significant advancement in anesthetic pharmacology and later led to the development of improved agents such as cisatracurium.
