From the FDA Drug Label
Because of its intermediate onset of action, cisatracurium is not recommended for rapid sequence endotracheal intubation.
Cisatracurium is not suitable for Rapid Sequence Intubation due to its intermediate onset of action 1.
From the Research
Suitability of Cisatracurium for Rapid Sequence Intubation
- Cisatracurium has been studied as a potential agent for rapid sequence intubation due to its favorable pharmacokinetic profile, including organ-independent Hofmann-elimination and less histamine release propensity 2.
- Research has shown that cisatracurium can provide good intubating conditions, although its onset time may be slower compared to other agents such as rocuronium 3, 4, 5.
- A study comparing cisatracurium and rocuronium found that despite a slower onset time, cisatracurium can provide comparable intubating conditions to rocuronium when used in a rapid sequence induction with remifentanil and propofol 4.
- Another study found that cisatracurium in doses of 0.2 mg/kg and 0.3 mg/kg provides good-to-excellent intubating conditions within less than 3 minutes, with a faster onset time observed at the higher dose 6.
- However, rocuronium has been shown to have a faster onset of action compared to cisatracurium, with one study finding that rocuronium produced favorable intubating conditions with good hemodynamic stability and a statistically significant faster onset of action 5.
Key Findings
- Cisatracurium has a slower onset time compared to rocuronium, but can still provide good intubating conditions 3, 4, 5.
- The optimal dose of cisatracurium for intubating conditions and onset of neuromuscular blockade is likely between 0.2 mg/kg and 0.3 mg/kg 6.
- Cisatracurium has a favorable pharmacokinetic profile, with less histamine release propensity and organ-independent elimination 2.
Comparison with Other Agents
- Rocuronium has a faster onset of action compared to cisatracurium, but cisatracurium can still provide comparable intubating conditions in certain scenarios 4, 5.
- Cisatracurium may be a suitable alternative to succinylcholine for rapid sequence intubation, particularly in patients with certain medical conditions or allergies 2.