From the Guidelines
Cisatracurium for Rapid Sequence Intubation (RSI)
Cisatracurium cannot be recommended as a first-line agent for Rapid Sequence Intubation (RSI) due to its slower onset of action compared to other available options like suxamethonium and rocuronium 1.
- The ideal neuromuscular blocking agent for RSI should have a rapid onset of action to minimize the time between loss of consciousness and tracheal intubation, thereby reducing the risk of gastric aspiration.
- While cisatracurium has a favorable pharmacological profile with minimal side effects, its onset time is not as rapid as suxamethonium or high-dose rocuronium, which are traditionally used for RSI 1.
- Rocuronium, with its faster onset time, has been proposed as an alternative to suxamethonium for RSI, especially when used at higher doses (>0.9 mg/kg) 1.
- In clinical practice, the choice of neuromuscular blocking agent for RSI should be guided by the patient's specific needs, the urgency of the situation, and the clinician's familiarity with the drug, with suxamethonium and rocuronium generally being preferred due to their rapid onset of action.
From the FDA Drug Label
PRECAUTIONS: Because of its intermediate onset of action, cisatracurium is not recommended for rapid sequence endotracheal intubation.
Cisatracurium is not recommended for Rapid Sequence Intubation (RSI) due to its intermediate onset of action 2.
From the Research
Cisatracurium for Rapid Sequence Intubation (RSI)
- Cisatracurium is a non-depolarizing neuromuscular blocking agent that can be used for RSI, but its onset time is relatively slow compared to other agents like succinylcholine or rocuronium 3.
- Studies have shown that cisatracurium can provide good-to-excellent intubating conditions within 2-3 minutes when used at doses of 0.2 mg/kg or 0.3 mg/kg 4, 5.
- The onset time of cisatracurium can be influenced by the dose used, with higher doses resulting in faster onset times 4, 5.
- The use of cisatracurium for RSI may be beneficial in certain situations, such as when succinylcholine is contraindicated or when a longer duration of neuromuscular blockade is desired 3, 5.
- However, cisatracurium may not be the best choice for RSI in emergency situations where rapid intubation is critical, due to its slower onset time compared to other agents 3.
Comparison with Other Agents
- Cisatracurium has been compared to other neuromuscular blocking agents, such as rocuronium and succinylcholine, in terms of its onset time and intubating conditions 3.
- Rocuronium has a faster onset time than cisatracurium, but its duration of action is also longer 3.
- Succinylcholine has a very rapid onset time, but it can cause significant side effects, such as hyperkalemia and muscle fasciculations 3.
Dosing and Administration
- The recommended dose of cisatracurium for RSI is 0.1-0.2 mg/kg, with higher doses resulting in faster onset times and longer durations of action 4, 5.
- The use of a priming dose of cisatracurium has been studied, but its benefits are unclear 6.
- Cisatracurium can be administered with other anesthetic agents, such as propofol or etomidate, to facilitate intubation 7.