There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
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 has a slower onset time compared to other neuromuscular blocking agents like rocuronium and succinylcholine 2, 3.
- The recommended intubating dose of cisatracurium is 0.15 to 0.2 mg/kg (3 to 4 times ED95), which provides good intubating conditions within 2-3 minutes 2, 4.
- Studies have shown that cisatracurium can provide good-to-excellent intubating conditions, comparable to those achieved with equipotent doses of rocuronium, in a rapid sequence induction with remifentanil and propofol 5.
- Cisatracurium has a lower propensity for histamine release compared to other neuromuscular blocking agents, making it a suitable choice for patients with renal failure or other comorbidities 2, 6.
- The onset time and intubating conditions of cisatracurium are not significantly affected by renal function, but the recovery time may be prolonged in patients with renal failure 6.
Dosing and Administration
- A dose of 0.2 mg/kg or 0.3 mg/kg of cisatracurium provides good-to-excellent intubating conditions within less than 3 minutes 4.
- Cisatracurium can be administered as a bolus dose immediately after induction of anesthesia, and intubation can be attempted when the anesthesiologist thinks it is appropriate 3, 5.
- The choice of cisatracurium, especially for patients with organ dysfunction, seems to be beneficial due to its organ-independent Hofmann elimination and lower histamine release propensity 6.
Comparison with Other Agents
- Rocuronium has a faster onset time compared to cisatracurium, but cisatracurium can provide comparable intubating conditions in a rapid sequence induction with remifentanil and propofol 5.
- Succinylcholine is still considered a suitable choice for rapid-sequence induction, but cisatracurium can be used as an alternative in patients with certain comorbidities or contraindications to succinylcholine 2.