Difference between revisions of "Cisatracurium"
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Cisatracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocking agents used commonly for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit. | |||
==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->== | ==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->== | ||
Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit | * Optimizing tracheal intubation condition among patients with renal or hepatic dysfunction | ||
** Abduction of vocal cords | |||
** Opening of mouth | |||
** Reduction in coughing and gagging | |||
* Provide surgical relaxation mainly in patients with renal or hepatic dysfunction. | |||
* Optimizing mechanical ventilation conditions | |||
** Reduction in bucking/coughing | |||
** Reduction in breath stacking | |||
* Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma. | |||
==Contraindications<!-- List contraindications and precautions for use of the drug. -->== | ==Contraindications<!-- List contraindications and precautions for use of the drug. -->== | ||
===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->=== | ===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->=== | ||
* Known hypersensitivity | |||
===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->=== | ===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->=== | ||
* Patients with myasthenia gravis/myathenic syndrome | |||
* Amyotrophic lateral sclerosis | |||
* Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous | |||
* Familial periodic paralysis hyperkalemia | |||
* Guillain-Barré syndrome | |||
* Muscular dystrophy (Duchenne type) | |||
* Myotonia including dystrophic, congenital,, and paramyotonia | |||
* Patient may have resistance include: | |||
** Burn injury | |||
** Cerebral palsy | |||
** Hemiplegia (on the affected side) | |||
** Muscular denervation | |||
** Severe chronic infection such as tetanus and botulism | |||
==Pharmacology== | ==Pharmacology== | ||
===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->=== | ===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->=== | ||
* Eliminated via Hofmann elimination | |||
* Roughly about 3 times the potency of atracurium | |||
====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->==== | ====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->==== | ||
Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites. | |||
====Adverse effects<!-- Describe any potential adverse effects of the drug. -->==== | ====Adverse effects<!-- Describe any potential adverse effects of the drug. -->==== | ||
* Anaphylactic reaction | |||
* Histamine release leading to hypotension, bronchospasm, rash | |||
* Bradycardia | |||
* Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm | |||
* Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately. | |||
* Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing. | |||
===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ||
Revision as of 19:31, 2 January 2023
Cisatracurium
 | |
| Clinical data | |
| Drug class |
Neuromuscular blocker |
|---|---|
| Routes of administration |
IV |
| Dosage | |
| Pharmacodynamics | |
| Mechanism of action |
Nicotinic acetylcholine antagonism |
| Pharmacokinetics | |
| Physical and chemical data | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Cisatracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocking agents used commonly for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.
Uses
- Optimizing tracheal intubation condition among patients with renal or hepatic dysfunction
- Abduction of vocal cords
- Opening of mouth
- Reduction in coughing and gagging
- Provide surgical relaxation mainly in patients with renal or hepatic dysfunction.
- Optimizing mechanical ventilation conditions
- Reduction in bucking/coughing
- Reduction in breath stacking
- Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma.
Contraindications
Absolute contraindications
- Known hypersensitivity
Precautions
- Patients with myasthenia gravis/myathenic syndrome
- Amyotrophic lateral sclerosis
- Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
- Familial periodic paralysis hyperkalemia
- Guillain-Barré syndrome
- Muscular dystrophy (Duchenne type)
- Myotonia including dystrophic, congenital,, and paramyotonia
- Patient may have resistance include:
- Burn injury
- Cerebral palsy
- Hemiplegia (on the affected side)
- Muscular denervation
- Severe chronic infection such as tetanus and botulism
Pharmacology
Pharmacodynamics
- Eliminated via Hofmann elimination
- Roughly about 3 times the potency of atracurium
Mechanism of action
Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.
Adverse effects
- Anaphylactic reaction
- Histamine release leading to hypotension, bronchospasm, rash
- Bradycardia
- Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm
- Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
- Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
Pharmacokinetics
Chemistry and formulation
History
References
Top contributors: Cornel Chiu and Chris Rishel