| Name: | CISATRACURIUM (NimbexR) |
| Classification: | non-depolarizing neuromuscular blocker; skeletal muscle relaxant - used to facilitate mechanical ventilation reduces airway resistance/pressures reduces metabolic rate and O2 consumption used in the management of tetanus
- safe for use in patients with malignant hyperthermia
may be used to stop muscle activity during a seizure but has no anticonvulsant properties Table 1. Indications and Dosing of Neuromuscular Blockers (NMB’s) | Indications | Recommended NMB | Dose | | Single dose for procedure, mechanical ventilation or hypothermia | Rocuronium | 0.6-1.2 mg/kg
(round to nearest 10 mg) | | Continuous infusion for hypothermia or mechanical ventilation | Rocuronium | 0.5-0.7 mg/kg/hr | | Continuous infusion for hypothermia or mechanical ventilation with renal or hepatic dysfunction. | Cisatracurium | (0.03 - 0.6 mg/kg/hour) |
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| Dose: | - IV Direct:
- IV Infusion:
- 0.03-0.6 mg/kg/hr (equal to 0.5-10 mcg/kg/min)
dose reduction is not required in either hepatic or renal insufficiency; dose requirements may be increased in patients with severe hepatic disease. |
| Administration: | IV Infusion:
2mg/mL (undiluted) in syringe - mechanical ventilation must be increased to provide full support prior to administration
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| Adverse Effects: | - bradycardia or tachycardia
- hypertension or hypotension
- bronchospasm
- anaphylaxis
- hypothermia
- corneal ulceration
- excessive salivation
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| Caution: | - in history of myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis or other neuromuscular disease; respiratory acidosis; hypokalemia; asthma; anaphylactic reactions
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| Antidote: | - anticholinesterase agents, e.g. neostigmine
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| Drug Interactions: | - cisatracurium + aminoglycosides = increased neuromuscular blocking effect
- cisatracurium + steroids = possible increased risk of myopathy
- cisatracurium + anticonvulsants = possible decreased effect of cisatracurium
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| Monitoring Therapy: | - continuous heart rate and rhythm
- continuous blood pressure
- continuous End Tital Carbon Dioxide monitoring
- continuous oxygen saturation
- ventilator parameters and monitor alarms
- chest sounds
- blood gases
- electrolytes
- temperature
- eyes - keep moist and closed
- skin/limb support
- Routine use of Train of four (T.O.F) is no longer required
NOTE: - Has no CNS effects, therefore, consider patients able to hear and comprehend.
- Has no analgesic or sedative properties; patients require continuous analgesic and sedative administration.
- Pupils and GI tract are not affected.
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| Adult Critical Care Protocol: | - Patient must be fully ventilated on a controlled mode before administration of any dose of neuromuscular blockade.
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care providing that the patient is receiving full mechanical ventilation.
- A nurse in Adult Critical Care may administer the initial dose.
- Administration of anaesthetic dosing of analgesics and sedatives must PRECEED initiation of neuromuscular blocking agents.
- A continuous infusion of analgesics and sedatives must be administered with an infusion of neuromuscular blocking agents.
- Continuous infusion must be administered via an infusion pump.
- May be titrated by a nurse in Adult Critical Care.
- Patient requires placement of an arterial line to monitor BP.
- Patient requires End Tidal CO2 monitoring.
- Continuous infusions must be administered by infusion pump device and the pump library must be enabled.
- A bedside sign alerting staff of neuromuscular blocker use must be displayed
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