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
Cisatracurium for Rapid Sequence Intubation
- Cisatracurium is a nondepolarizing muscle relaxant that has been studied for its suitability in rapid sequence intubation (RSI) 2, 3, 4, 5, 6.
- The onset time of cisatracurium is generally slower compared to other muscle relaxants like rocuronium, but it has been shown to provide good intubating conditions with doses of 0.15-0.3 mg/kg 3, 4, 5, 6.
- Studies have demonstrated that cisatracurium can provide excellent intubating conditions, comparable to those achieved with equipotent doses of rocuronium, when used in anesthesia induced with remifentanil and propofol 5.
- The optimal dose of cisatracurium for intubating conditions and onset and offset of neuromuscular blockade has been evaluated, with doses of 0.2 mg/kg and 0.3 mg/kg providing good-to-excellent intubating conditions within less than 3 minutes 6.
- Cisatracurium has been shown to have a low propensity for histamine release, making it a suitable choice for patients with a history of allergic reactions or those who are at risk of histamine release 2, 3, 4.
Comparison with Other Muscle Relaxants
- Cisatracurium has been compared to other muscle relaxants like rocuronium and vecuronium in terms of onset time, intubating conditions, and hemodynamic parameters 3, 4, 5.
- Rocuronium has been shown to have a faster onset time compared to cisatracurium, but cisatracurium has been found to provide comparable intubating conditions with equipotent doses 3, 5.
- Vecuronium has been shown to have a similar onset time to cisatracurium, but cisatracurium has been found to have a lower propensity for histamine release 4.
Clinical Implications
- Cisatracurium can be considered a suitable choice for rapid sequence intubation, particularly in patients with a history of allergic reactions or those who are at risk of histamine release 2, 3, 4.
- The optimal dose of cisatracurium for intubating conditions and onset and offset of neuromuscular blockade should be carefully considered, with doses of 0.2 mg/kg and 0.3 mg/kg providing good-to-excellent intubating conditions within less than 3 minutes 6.
- Cisatracurium should be used in conjunction with other anesthetic agents, such as remifentanil and propofol, to provide optimal intubating conditions and minimize the risk of adverse reactions 5.