Therapeutic Effects: Paralysis

Anesthesia Implications

Surgeries Greater than 1 hour – The duration of action limits the use of this agent to surgeries expected to last an hour or more.

Rocuronium and Vecuronium alternative – This agent is especially good for patients that have compromised renal/hepatic failure. This is because it relies on Hofmann elimination and ester hyrolysis to be metabolized.

Defaciculation – Cisatracurium is NOT effective as a defaciculant.

Volatile Inhaled Anesthetics – Volatile anesthetics potentiate the neuromuscular blockade when using cisatracurium. Doses should be based on ideal body weight in the obese.

No histamin release – No histamine release and very little laudanosine as a metabolite, which makes this an ideal agent over atracurium.

Sugammadex – Neuromuscular blockade using Nimbex will have a faster onset and deeper level of blockade when administered after a sugammadex reversal.

Neonates – Nimbex is a very useful induction agent for neonates. There is no dependence on liver function, which is reduced in the neonate.

IV push dose

Intubating: 0.15 mg/kg
Redosing/Maintenance: 0.1 mg/kg

Reversal: Neostigmine 40 mcg/kg. MAX dose in adults is 5mg. Neostigmine is typically administered (where not contraindicated) with glycopyrrolate. The dose of glycopyrrolate is 0.2 mg for every 1 mg of Neostigmine. Median recovery times from a TOF ratio of 0.5 back to 1.0 is 4.3 minutes.

Classification: Non-Depolarizing Neuromuscular Blocker, Bisquaternary Ammonium Benzylisoquinoline

Time to Onset: 4-5 minutes

Time to Peak: 4-5 minutes

Duration: 45-60 minutes after intubation. 35-45 minutes after redosing.

Method of Action: The nicotinic cholinergic receptor at the skeletal muscle motor end-plate normally receives acetylcholine, which leads to muscle contraction. Cisatracurium is a competitive antagonist to acetylcholine. This means it essentially “blocks” acetylcholine by binding at the same receptor, preventing skeletal muscle contraction.

Metabolism: Hofmann Elimination and Ester Hydrolysis

Elimination: Hofmann Elimination and Ester Hydrolysis

Additional Notes:
As pH or temperature increases, so does the metabolism (Hofmann elimination)