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Cisatracurium
📖 About: BNF link
- 💉 A benzylisoquinolinium non-depolarising muscle relaxant.
- 🔬 One of the ten isomers of atracurium.
- ⚖️ More potent than the racemate mixture of atracurium.
- 🫁 Causes less histamine release and fewer cardiovascular effects than atracurium.
⚙️ Mode of Action
- Acts as a competitive antagonist at nicotinic acetylcholine receptors on the motor end plate.
- Blocks depolarisation and prevents skeletal muscle contraction.
- Neuromuscular block is reversed by acetylcholinesterase inhibitors (e.g. neostigmine, usually co-administered with glycopyrronium/atropine).
- Metabolised by Hoffman elimination — dependent on temperature and pH, making it independent of renal/hepatic clearance.
💊 Indications / Dose
- Facilitation of endotracheal intubation (non-rapid sequence).
- Muscle relaxation during general anaesthesia to aid intubation and surgical field exposure.
- Use in ICU patients requiring mechanical ventilation.
- Given as a bolus or infusion (infusion more common in ICU).
- Initial dose: 150 mcg/kg (based on ideal body weight).
- Infusion rates vary — titrate to neuromuscular monitoring.
🔄 Interactions
- 🚫 Do not mix with thiopentone — alkaline pH causes precipitation. Flush cannula well if both drugs are used.
⚠️ Cautions
- 🔥 Burns patients may require higher doses due to receptor upregulation.
- ⚡ Electrolyte disturbances (e.g. hypermagnesaemia) → prolonged block.
- ❄️ Hypothermia → slows Hoffman elimination → prolonged effect.
- 💪 Myasthenia gravis → marked sensitivity, profound/prolonged block at low doses.
🚫 Contraindications
- Not for intramuscular use.
- Must never be given without staff immediately available who can secure the airway.
⚡ Side Effects
- Rare reports of bronchospasm (more with atracurium).
- Hypersensitivity reactions.
- Critical care myopathy/weakness with prolonged use.
📚 Reference
- Wastila WB, Maehr RB, Turner GL, Hill DA, Savarese JJ. Comparative pharmacology of cisatracurium (51W89), atracurium, and five isomers in cats. Anesthesiology. 1996;85(1):169–77. doi:10.1097/00000542-199607000-00023. PMID: 8694363.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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