Cisatracurium is an intermediate-duration, non-depolarizing neuromuscular-blocking agent, the purified form of one of the 10 stereoisomers of atracurium which is cleared primarily by Hofmann elimination. It produces minimal cardiovascular change and does not release histamine even at up to eight times the dose that produced 95percnt; of the maximum response (ED95) for neuromuscular block. At twice the ED95the pharmacodynamic profile of cisatracurium is similar to that of an equipotent dose of atracurium apart from a slightly slower onset of action. A more rapid onset is produced when the dose is increased. The clinically effective duration of action, as assessed by the twitch response of the adductor policis muscle to a train of four stimulations, increases with increasing doses; however, doubling the dose only adds approximately 23 min to the duration of clinically effective block. The clinically effective duration of action ranges from 45 min after twice the ED95(0.1 mg/kg) to approximately 90 min after eight times the Ed95(0.4 mg/kg). Neuromuscular block can be maintained with incremental or repeat bolus doses or continuous infusions of cisatracurium without any cumulative neuromuscular-blocking effect. Neuromuscular block induced with cisatracurium can be readily reversed using anticholinesterase agents. Cisatracurium has a predictable and rapid rate of spontaneous recovery (5ndash;95percnt; recovery about 30 min) irrespective of the initial dose administered or the duration of maintenance dosing.
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