Cisatracurium
Mechanism :
Cisatracurium Besylate binds to the nicotinic acetylcholine (cholinergic) receptors in the motor endplate and blocks access to the receptors. In the process of binding, the receptor is actually activated - causing a process known as depolarization. Since it is not degraded in the neuromuscular junction, the depolarized membrane remains depolarized and unresponsive to any other impulse, causing muscle paralysis.
Indication :
- Adjunct to general anaesthesia provide skeletal muscle relaxation.
Contraindications :
Hypersensitivity to cisatracurium (or benzyl alcohol if 10 mL vial is used).
RSI (due to intermediate onset).
Dosing :
Neuromuscular blockade:
1-24 months:
0.15 mg/kg IV over 5-10 seconds during halothane/opioid anaesthesia.
2-12 years:
0.1-0.15 mg/kg IV over 5-15 seconds during halothane/opioid anaesthesia.
IV infusion (During extended surgery):
<2 years:
Safety and efficacy not established.
>2 years:
3 mcg/kg/min post IV bolus (for prevention of rapid spontaneous recovery of NM blockade), followed by 1-2 mcg/kg/min of maintenance dose (dose range of 0.5-10 mcg/kg/min).
Infusion rate to be decreased by 30-40% in case given during stable isoflurane or enflurane anaesthesia.
Adverse Effect :
Histamine release associated bradycardia and bronchospasm, flushing, hypotension, rash.
Interaction :
Aminoglycosides: May potentiate, prolong neuromuscular blockade.
Hepatic Dose :
No dosage adjustments are recommended.