Understanding Anesthesiology - The Global Regional Anesthesia ...

Cis-Atracurium
Class
Non-depolarizing skeletal muscle relaxant (NDMR); intermediate-acting
Mechanism of Action
Competitive inhibitor at the acetylcholine receptors of the post-synaptic cleft of the neuromuscular
junction.
Dose
Intubation: 0.15-0.2 mg/kg
Maintenance bolus: 0.03 mg/kg
Maintenance infusion: 1-2 $g/kg/minute
Onset
Dose-dependent:
2 minutes (0.15 mg/kg)
1.5 minutes (0.2 mg/kg)
Duration
Dose dependent:
55 minutes (0.15 mg/kg)
65 minutes (0.2 mg/kg)
20 minutes (maintenance bolus 0.03 mg/kg)
Elimination
Hoffman elimination (77%), renal (16%)
Effects
MSK
The neuromuscular blockade effects of non-depolarizing muscle relaxants are potentiated by
succinylcholine, volatile anesthetics, aminoglycosides, lithium, loop diuretics, lidocaine, magnesium,
lithium, ganglionic blockers, hypothermia, hypokalemia and respiratory acidosis.
Enhanced neuromuscular blockade is seen in patients with myasthenia gravis or myopathies.
The effects of NDMR are antagonized by cholinesterase inhibitors. Increased resistance to
NDMR is seen in patients on theophylline, burn patients and those with paresis or paralysis.
Misc.
Histamine release may occur with rapid administration or higher dosages. Produces 5-10x less
laudanosine metabolite than atracurium. Muscle relaxants are the most common cause of
anaphylactoid reactions under general anesthesia.
Related Glossary Terms
Anticholinesterase, Atracurium, Laudanosine, Neuromuscular junction, Non-depolarizing
muscle relaxants, Pancuronium, Peripheral nerve stimulator, Residual block, Rocuronium
Index
Find Term
Chapter 3 - General Anesthesia
Chapter 6 - Drug Finder
Chapter 6 - Muscle Relaxants