Cisatracurium

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	Comprehensive
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.