Adult Dosing
Neuromuscular blockade induction
Neuromuscular blockade maintenance
Intermittent IV
- 0.03 mg/kg IV q20 min PRN
- Give 1st maintenance dose 40-60 min after induction dose
Continuous IV
- 1-2 mcg/kg/min IV
- Start: 3 mcg/kg/min IV after induction dose
Pediatric Dosing
Neuromuscular blockade induction
- Infants 1-23 months: 0.15 mg/kg IV
- Children 2-12 yrs: 0.1-0.15 mg/kg IV
- Children > 12 yrs: Same as adult dose
[Outline]
- Doses should be individualized and administer drug by or under the supervision of experienced clinicians who are familiar with the drug's actions and the possible complications of its use
- Not recommended for rapid sequence intubation, intermediate acting agent
- Assure that personnel and facilities for resuscitation and life support (tracheal intubation, artificial ventilation, oxygen therapy), and an antagonist of cisatracurium are immediately available prior to administration of drug
- With a peripheral nerve stimulator measure neuromuscular function during the administration to monitor drug effect, to determine the need for additional doses, and confirm recovery from neuromuscular block
- To avoid distress to the patient, never induce neuromuscular block before unconsciousness as cisatracurium has no known effect on consciousness, pain threshold or cerebration
- Neuromuscular blocking agents have been reported to cause severe anaphylactic reactions which may be life-threating and fatal. Keep appropriate emergency treatment readily available in case such reactions occur
- Use cautiously in patients who had anaphylactic reactions to other neuromuscular blocking agents in the past as there have been reports of cross-reactivity among drugs of this class
- Administer cautiously in newborn infants as one of the ingredient benzyl alcohol may cause neurological and other complications which are sometimes fatal
- Cisatracurium is not recommended for rapid sequence endotracheal intubation due to its intermediate onset of action
- Use Max. 0.02 mg/kg of cisatracurium in patients with neuromuscular diseases to assess the level of neuromuscular block and to monitor dosage requirements
- To administer cisatracurium in burn patients, the possibility of increased dosing requirements and shortened duration of action must be considered
- Perform neuromuscular monitoring on a non-paretic limb in hemiparesis or paraparesis patients to avoid inaccurate dosing of cisatracurium as it may demonstrate resistance to nondepolarizing muscle relaxants in the affected limbs
- Concomitant isoflurane or enflurane reduce maintenance IV infusion 30-40%
- Reduce infusion rate by approx. 50% in coronary artery bypass surgery with induced hyperthermia
- In ICU use, monitor neuromuscular function during administration with a nerve stimulator and accordingly decide doses
- Clinicians should be prepared to recognize and treat malignant hyperthermia
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Neuromuscular disorders
- Endocrine disorders
- Trauma, burns patients
- Debilitated patients
- Hemiparesis or paraparesis
- Myasthenia gravis
- Cardiovascular disease
- History of severe anaphylactic reactions
- Acid-base disorder
- Long-term use in ICU
- Obese patients
- Carcinomatosis
- Cerebral palsy
- Severe hypothermia
- Dehydration
- Electrolyte abnormalities
Pregnancy Category:B
Breastfeeding: Safety unknown; manufacturer advises caution while administering to nursing woman
