Cisatracurium besylate


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Cisatracurium besylate
Cisatracurium besylate
Cisatracurium besylate
(sis-ah-trah- KYOU-ree-um)
Pregnancy Category: B Nimbex (Rx)

Classification: Neuromuscular blocking agent

See Also: See also Neuromuscular Blocking Agents,.

Action/Kinetics: Nondepolarizing neuromuscular blocking agent that binds competitively to cholinergic receptors on the motor end-plate, resulting in antagonism of the action of acetylcholine and therefore neuromuscular blockade. The neuromuscular blocking potency of cisatracurium is about three times greater than that for atracurium. Intermediate onset and duration. Time to maximum blockade: 2 min. Time to recovery: Approximately 55 min. Continuous infusion for up to 3 hr may be undertaken without tachyphylaxis or cumulative neuromuscular blockade. The time required for recovery following successive maintenance doses does not change with the number of doses given, provided that partial recovery is allowed to occur between doses. Onset, duration, and recovery are faster in children. About 95% of a dose is excreted as metabolites and unchanged drug (10%) in the urine and 4% is eliminated through the feces. Laudanosine, a major biologically active metabolite with no neuromuscular activity, may cause transient hypotension and cerebral excitatory effects (in high doses).

Uses: Neuromuscular blocking agent for in-patients and out-patients as an adjunct to general anesthesia, to facilitate tracheal intubation, and to cause skeletal muscle relaxation during surgery or mechanical ventilation in the intensive care unit.

Contraindications: Hypersensitivity to cisatracurium or other bis-benzylisoquinolinium agents or hypersensitivity to benzyl alcohol. Use for rapid-sequence ET intubation due to its intermediate onset of action.

Special Concerns: Since the drug has no effect on consciousness, pain threshold, or cerebration, administration should not be undertaken before unconsciousness. May cause a profound effect in those with myasthenia gravis or the myasthenic syndrome. Burn clients may require higher doses. Onset time is faster (about 1 min) and recovery is slower (by about 1 min) in clients with impaired hepatic function. The time to maximum blockage is about 1 min slower in geriatric clients and in those with impaired renal function. Use with caution during lactation. Safety and efficacy have not been determined in children less than 2 years of age.

Side Effects: Bradycardia, hypotension, flushing, bronchospasm, rash.

Overdose Mangement: Symptoms: Neuromuscular blockade beyond the time needed for surgery and anesthesia. Treatment: Maintain a patent airway and control ventilation until recovery of normal function is assured. Once recovery begins, facilitate the process by using neostigmine or edrophonium with an anticholinergic drug. Do not give these antidotes when complete blockade is evident.

Drug Interactions: Aminoglycosides / Effect of cisatracurium Bacitracin / Effect of cisatracurium Carbamazepine / Resistance to neuromuscular blockage slightly shorter duration. Clindamycin / Effect of cisatracurium Colistin, sodium colistimethate / Effect of cisatracurium Enflurane/nitrous oxide/oxygen / Duration of cisatracurium Isoflurane/nitrous oxide/oxygen / Duration of cisatracurium Lincomycin / Effect of cisatracurium Lithium / Effect of cisatracurium Local anesthetics / Effect of cisatracurium Magnesium salts / Effect of cisatracurium Phenobarbital / Resistance to neuromuscular blockade slightly shorter duration Polymyxins / Effect of cisatracurium Procainamide / Effect of cisatracurium Quinidine / Effect of cisatracurium Succinylcholine / Time to onset of maximum block of cisatracurium is about 2 min faster Tetracyclines / Effect of cisatracurium

How Supplied: Injection: 2 mg/mL, 10 mg/mL.

Dosage
?IV Bolus Neuromuscular blockade.
Adults, initial: Depending on the desired time to intubation and the anticipated length of surgery, either 0.15 or 0.2 mg/kg is used. These doses are components of a propofol/nitrous oxide/oxygen induction-intubation technique. Maintenance during prolonged surgery: 0.03 mg/kg given 40-50 min following an initial dose of 0.15 mg/kg and 50-60 min following an initial dose of 0.2 mg/kg.
Children, 2-12 years of age: 0.1 mg/kg over 5-10 sec during either halothane or opioid anesthesia. When given during stable opioid/nitrous oxide/oxygen anesthesia, 0.1 mg/kg produces maximum effects in about 2.8 min and a clinically effective blockade for 28 min.


?IV Infusion Neuromuscular blockade during extended surgery or use in the intensive care unit.
In the operating room or intensive care unit, following an initial bolus dose, a diluted solution can be given by continuous infusion to both adults and children over 2 years of age. The rate of administration is dependent on the response of the client determined by peripheral nerve stimulation. An infusion rate of 3 mcg/kg/min can be used to counteract rapid spontaneous recovery of neuromuscular blockade. Thereafter, an infusion rate of 1-2 mcg/kg/min is usually adequate to maintain blockade. Reduce the infusion rate by 30%-40% when given during stable isoflurane or enflurane anesthesia.

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