Cisatricurium: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: | *Type: [[Neuromuscular blocker]] | ||
*Dosage Forms: | *Dosage Forms: Injection | ||
*Routes of Administration: | *Routes of Administration: IV | ||
*Common Trade Names: | *Common Trade Names: Nimbex | ||
==Adult Dosing== | ==Adult Dosing== | ||
*Induction | |||
**150-200 mcg/kg IV x 1 | |||
*Maintenance | |||
**Intermittent | |||
***30 mcg/kg IV q20 min PRN (Start ~50 min after induction dose) | |||
**Continuous | |||
***1-2 mcg/kg/min IV (though rates may vary widely) | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Induction | |||
**1-23 months: 150 mcg/kg IVx1 | |||
**2-12 years old: 100-150 mcg/kg IV x1 | |||
**>12 years old: 150-200 mcg/kg IV x1 | |||
*Maintenance | |||
**>2 years old: 1-2 mcg/kg min (though rates may vary widely) | |||
==Special Populations== | ==Special Populations== | ||
===[[Drug pregnancy categories|Pregnancy Rating]]=== | ===[[Drug pregnancy categories|Pregnancy Rating]]=== | ||
* | * Caution advised, insufficient data | ||
===Lactation risk=== | ===Lactation risk=== | ||
* | *Caution advised, insufficient data | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: | *Adult: Not defined, consider extended interval between dose administration and intubation if [[ESRD]] | ||
*Pediatric: | *Pediatric: Not defined, consider extended interval between dose administration and intubation if [[ESRD]] | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Adult: | *Adult: Not defined, onset 1 minute faster than healthy controls | ||
*Pediatric: | *Pediatric: Not defined, onset 1 minute faster than healthy controls | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*Neonates (benzyl alcohol-containing forms) | |||
*Caution if neuromuscular disease, burns, asthma, electrolyte abnormalities | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Hypersensitivity reaction | |||
*[[Anaphylaxis]]/[[Anaphylactoid reaction]] | |||
*Bronchospasm | |||
*Hypotension | |||
*Respiratory depression | |||
*Prolonged paralysis | |||
===Common=== | ===Common=== | ||
*Bradycardia | |||
*Hypotension | |||
*Flushing | |||
*Bronchospasm | |||
*Rash | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 22-29 minutes | ||
*Metabolism: | *Metabolism: Liver | ||
*Excretion: | *Excretion: Urine | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
*Binds to motor end-plate cholinergic receptor, antagonizing acetylcholine activity and producing neuromuscular blockade | |||
==Comments== | ==Comments== | ||
Cisatricurium can also be used as adjunct therapy for [[ARDS]]. Clinical practice guidelines recommend a short course for patients with early | |||
sepsis-related ARDS with a PaO2/FiO2 less than 150 mmHg.<ref>Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–1116. doi:10.1056/NEJMoa1005372</ref> | |||
==See Also== | ==See Also== | ||
*[[Neuromuscular blocker]] | |||
==References== | ==References== | ||
Latest revision as of 12:44, 24 March 2020
Administration
- Type: Neuromuscular blocker
- Dosage Forms: Injection
- Routes of Administration: IV
- Common Trade Names: Nimbex
Adult Dosing
- Induction
- 150-200 mcg/kg IV x 1
- Maintenance
- Intermittent
- 30 mcg/kg IV q20 min PRN (Start ~50 min after induction dose)
- Continuous
- 1-2 mcg/kg/min IV (though rates may vary widely)
- Intermittent
Pediatric Dosing
- Induction
- 1-23 months: 150 mcg/kg IVx1
- 2-12 years old: 100-150 mcg/kg IV x1
- >12 years old: 150-200 mcg/kg IV x1
- Maintenance
- >2 years old: 1-2 mcg/kg min (though rates may vary widely)
Special Populations
Pregnancy Rating
- Caution advised, insufficient data
Lactation risk
- Caution advised, insufficient data
Renal Dosing
- Adult: Not defined, consider extended interval between dose administration and intubation if ESRD
- Pediatric: Not defined, consider extended interval between dose administration and intubation if ESRD
Hepatic Dosing
- Adult: Not defined, onset 1 minute faster than healthy controls
- Pediatric: Not defined, onset 1 minute faster than healthy controls
Contraindications
- Allergy to class/drug
- Neonates (benzyl alcohol-containing forms)
- Caution if neuromuscular disease, burns, asthma, electrolyte abnormalities
Adverse Reactions
Serious
- Hypersensitivity reaction
- Anaphylaxis/Anaphylactoid reaction
- Bronchospasm
- Hypotension
- Respiratory depression
- Prolonged paralysis
Common
- Bradycardia
- Hypotension
- Flushing
- Bronchospasm
- Rash
Pharmacology
- Half-life: 22-29 minutes
- Metabolism: Liver
- Excretion: Urine
Mechanism of Action
- Binds to motor end-plate cholinergic receptor, antagonizing acetylcholine activity and producing neuromuscular blockade
Comments
Cisatricurium can also be used as adjunct therapy for ARDS. Clinical practice guidelines recommend a short course for patients with early sepsis-related ARDS with a PaO2/FiO2 less than 150 mmHg.[1]
See Also
References
- ↑ Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–1116. doi:10.1056/NEJMoa1005372