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 been studied as a potential agent for rapid sequence intubation (RSI) due to its favorable pharmacokinetic profile 2, 3, 4, 5.
- The onset time of cisatracurium can be as rapid as vecuronium when administered in a dose of 0.25 mg/kg 2.
- Studies have shown that cisatracurium provides good-to-excellent intubating conditions within less than 3 minutes when used in doses of 0.2 mg/kg and 0.3 mg/kg 4.
- Cisatracurium has been compared to rocuronium for intubation in anesthesia induced by remifentanil and propofol, with similar intubating conditions and hemodynamic changes observed in both groups 5.
- While cisatracurium may have a slower onset time compared to rocuronium, it can still provide acceptable intubating conditions, making it a viable alternative for RSI 5.
Dosing and Efficacy
- The optimal dose of cisatracurium for RSI has been investigated, with studies suggesting that doses of 0.2 mg/kg and 0.3 mg/kg provide good-to-excellent intubating conditions 4.
- A study comparing different doses of atracurium (another non-depolarizing neuromuscular blocker) found that a higher dose (1 mg/kg) achieved excellent intubation conditions in a larger proportion of patients compared to a lower dose (0.75 mg/kg) 6.
- The duration of muscle relaxation with cisatracurium has been shown to be longer with higher doses, which may be beneficial for certain surgical procedures 4, 6.
Safety and Hemodynamic Stability
- Cisatracurium has been found to have a low propensity for histamine release, which can contribute to hemodynamic instability 2, 3.
- Studies have reported minimal hemodynamic changes with cisatracurium, including changes in heart rate and mean arterial blood pressure 2, 3, 4, 5.
- The use of cisatracurium for RSI has been shown to be safe and effective, with no significant differences in hemodynamic parameters compared to other neuromuscular blockers 5.