From the Guidelines
The recommended induction dose of cisatracurium is 0.1–0.2 mg/kg. This dose is based on the most recent evidence from the European Heart Journal in 2023 1.
Key Points
- Cisatracurium is a non-depolarizing neuromuscular blocking agent that works by competitively binding to acetylcholine receptors at the neuromuscular junction, preventing muscle contraction.
- The duration of action is approximately 35–45 min, as indicated in the study 1.
- Cisatracurium undergoes non-enzymatic plasma degradation, making it a preferred agent in renal and hepatic impairment, as noted in the study 1.
- It is essential to administer cisatracurium after induction of anesthesia and to use it with neuromuscular monitoring.
- Reversal agents like sugammadex or neostigmine with an anticholinergic should be available when using cisatracurium.
Considerations
- The choice of neuromuscular blocking agent should be based on the patient's individual needs and medical history.
- Cisatracurium is a suitable option for patients with organ dysfunction due to its unique degradation process.
- The study 1 provides guidance on the use of cisatracurium in specific clinical contexts, such as targeted temperature management after cardiac arrest.
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