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
Suitability of Cisatracurium for Rapid Sequence Intubation
- Cisatracurium has a slower onset of action compared to other neuromuscular blocking agents like rocuronium and succinylcholine 2, 3, 4.
- The recommended intubating dose of cisatracurium is 0.15 to 0.2 mg/kg, which is 3 to 4 times the ED95 2.
- Studies have shown that cisatracurium can provide good-to-excellent intubating conditions, but the onset time is significantly longer compared to rocuronium 3, 5, 4.
- A study found that cisatracurium in doses of 0.2 mg/kg and 0.3 mg/kg provides good-to-excellent intubating conditions within less than 3 minutes 5.
- Another study found that despite its slower onset time, cisatracurium can provide quite good intubating conditions comparable to those achieved with equipotent doses of rocuronium in anesthesia induced with remifentanil and propofol 4.
Comparison with Other Neuromuscular Blocking Agents
- Rocuronium has a faster onset of action and is often preferred for rapid sequence intubation 2, 3, 6.
- Succinylcholine is still the most frequently used muscle relaxant for rapid-sequence induction due to its fast onset and recovery, despite its well-known side effects 6.
- Rapacuronium has been associated with dose-dependent respiratory side effects, limiting its usefulness in rapid sequence intubation 2, 6.
Clinical Considerations
- The choice of muscle relaxant for rapid sequence intubation depends on various factors, including the patient's airway assessment, the need for rapid intubation, and the potential for difficult intubation 6.
- Cisatracurium may be a suitable alternative for rapid sequence intubation in certain situations, but its slower onset time should be taken into consideration 3, 5, 4.