What is the use of Nimbex (Cisatracurium)?

From the Guidelines

Nimbex, also known as cisatracurium besylate, is a neuromuscular blocking agent primarily used during surgery and mechanical ventilation to cause muscle relaxation, with a recommended dosage of 0.15-0.2 mg/kg initially, followed by maintenance doses of 0.03 mg/kg as needed, and a continuous infusion of 3 mcg/kg/min for intensive care patients requiring mechanical ventilation, as supported by the most recent and highest quality study 1.

Key Points

• The typical dosage for surgical procedures is 0.15-0.2 mg/kg initially, followed by maintenance doses of 0.03 mg/kg as needed.
• For intensive care patients requiring mechanical ventilation, a continuous infusion of 3 mcg/kg/min is often used, adjusted based on patient response.
• Nimbex works by competing with acetylcholine at receptor sites on the motor end plate, preventing muscle contraction.
• Unlike other neuromuscular blockers, Nimbex undergoes Hofmann elimination, a process independent of liver or kidney function, making it suitable for patients with organ dysfunction.
• Side effects are minimal but may include hypotension and tachycardia.
• It's essential to note that Nimbex does not provide pain relief or sedation, so it must be used alongside appropriate anesthetics and analgesics.
• Reversal agents like neostigmine with glycopyrrolate or sugammadex may be needed to restore normal muscle function after use, as stated in 1.

Indications and Usage

• Nimbex is used to facilitate mechanical ventilation and improve oxygenation in patients with acute respiratory distress syndrome (ARDS), as shown in 1.
• It is also used to control muscle spasms and prevent ventilator asynchrony in critically ill patients, as mentioned in 1.

Monitoring and Dosing

• Patients receiving Nimbex should be monitored closely for signs of residual paralysis and adjusted accordingly, as recommended in 1.
• The dosage of Nimbex should be individualized based on the patient's response and underlying medical conditions, as stated in 1.

Safety and Efficacy

• Nimbex has been shown to be effective in improving oxygenation and reducing mortality in patients with ARDS, as demonstrated in 1.
• However, it is essential to weigh the benefits and risks of using Nimbex, particularly in patients with underlying medical conditions, as discussed in 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Cisatracurium Besylate Injection is an intermediate-onset/intermediate-duration neuromuscular blocking agent indicated for inpatients and outpatients as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU. The use of Nimbex (Cisatracurium) is as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during:

• Surgery
• Mechanical ventilation in the ICU 2

From the Research

Use of Nimbex (Cisatracurium)

• Nimbex (Cisatracurium) is a neuromuscular blocking agent used to facilitate tracheal intubation and provide muscle relaxation during surgery or mechanical ventilation 3, 4, 5.
• It is an intermediate-acting benzylisoquinolinium neuromuscular blocker that causes no clinically significant cardiovascular side effects or histamine release in doses up to 8 x ED95 in healthy patients 4.
• The recommended intubating dose of cisatracurium is 3 ED(95) 3, and it has been shown to provide good or excellent intubating conditions in over 90% of patients 5.
• Cisatracurium has been used in various clinical settings, including:
  • Facilitating tracheal intubation in patients undergoing elective surgery 3, 5.
  • Providing muscle relaxation during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) 6.
  • Pediatric anesthesia, where it has been shown to be effective and safe with an average duration of effect 7.
• The benefits of using cisatracurium include:
  • Improved arterial partial pressure of oxygen in patients with ARDS 6.
  • Reduced 90-day mortality in patients with early severe ARDS 6.
  • Increased ventilator-free days, ICU-free days, and organ failure-free days in patients with ARDS 6.
  • No appreciable fluctuations of hemodynamic parameters or other side effects, such as skin hyperemia or bronchial spasm, during anesthesia 7.