From the Guidelines
The recommended induction dose of cisatracurium is 0.1–0.2 mg/kg. This dose range is supported by the most recent evidence from the European Heart Journal in 2023 1. The study provides a table outlining the bolus dosing, infusion dose, duration, strengths, and limitations of various neuromuscular blockers, including cisatracurium.
Key Points
- The induction dose of 0.1–0.2 mg/kg is suitable for most adult patients.
- Cisatracurium has a duration of action of approximately 35–45 minutes.
- It undergoes non-enzymatic plasma degradation, making it a preferred agent in patients with renal and hepatic impairment.
- The medication has minimal cardiovascular effects and does not cause histamine release, making it suitable for hemodynamically unstable patients.
Considerations
- Monitoring with a peripheral nerve stimulator is essential when using neuromuscular blocking agents like cisatracurium.
- Reversal agents, such as sugammadex or neostigmine with an anticholinergic, should be readily available.
- The dose range may need to be adjusted based on individual patient factors, such as weight and medical history.
Additional Information
- Cisatracurium can be used in conjunction with sedation and analgesic medications to control shivering during targeted temperature management.
- The medication's pharmacokinetics and pharmacodynamics make it a suitable choice for patients with various comorbidities.
From the Research
Cisatracurium Induction Dose
- The recommended intubating dose of cisatracurium is 0.15 to 0.2 mg/kg (3 to 4 times ED95) 2
- Increasing the initial dose of cisatracurium from 0.1 to 0.15 and 0.2 mg/kg decreased the mean time of onset and increased the mean time of clinically effective duration 3
- A dose of 0.20 mg/kg of cisatracurium is recommended to ensure satisfactory intubating conditions when anaesthesia is induced using thiopentone 4
- Optimal conditions for intubation are met 120 seconds after administration of 0.15 mg/kg cisatracurium (ED95 × 3) following the induction of anesthesia 5
- The use of priming doses of 25% to 30% of ED95 may cause symptomatic muscle weakness, and the onset of muscle relaxation was significantly faster after priming with cisatracurium and rocuronium 6
Factors Affecting Cisatracurium Induction Dose
- The onset time of cisatracurium is significantly slower than after equipotent doses of atracurium 2
- The recovery properties of cisatracurium are affected by neither the size of the bolus dose nor by the duration of infusion 2
- Changes in pharmacodynamics and pharmacokinetics may affect the dosing of cisatracurium in ICU patients 5
- Females receiving cisatracurium and rocuronium had a faster onset of paralysis than males 6