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Cisatracurium besylate is an intermediate-acting, non-depolarizing neuromuscular blocking drug (NMBD). Cisatracurium has a benzylisoquinolinium structure and is the 1R cis-1-prime R cis isomer of atracurium. As an NMBD, it has found use as an adjunct to general anesthesia, facilitating tracheal intubation and providing skeletal muscle relaxation during surgery. Cisatracurium may also be used to provide skeletal muscle relaxation to facilitate mechanical ventilation in an intensive care unit setting but must be used with sedation. This activity reviews indications, mechanism of action, administration, contraindications, monitoring, and toxicity associated with cisatracurium and the role of the interprofessional team in caring for patients who have received cisatracurium. Objectives: Identify the appropriate indications and contraindications for cisatracurium administration based on the patient's clinical condition and individual characteristics. Screen patients for factors such as renal or hepatic dysfunction, electrolyte imbalances, or concurrent medications that may impact the use of cisatracurium. Assess the efficacy and safety of cisatracurium during its administration, monitoring the patient's response to therapy and adjusting the dosage as necessary. Communicate and collaborate with other healthcare professionals, such as anesthesiologists, pharmacists, and nurses, to ensure coordinated and safe administration of cisatracurium. Access free multiple choice questions on this topic.

Overdose with cisatracurium may result in neuromuscular blockade beyond the time needed for surgery and anesthesia. The primary treatment is maintaining sedation, a patent airway, and controlled ventilation until recovery of neuromuscular function is assured. There should be no attempt at reversal if there is evidence or suspicion of complete neuromuscular blockade. Once recovery from blockade begins, from the evidence of peripheral nerve stimulation, the neuromuscular blockade may be reversed with an anticholinesterase agent (eg, neostigmine) in conjunction with an anticholinergic agent (eg, glycopyrrolate). As with other nondepolarizing neuromuscular blocking agents, the more full the neuromuscular blockade at the point of reversal, the longer the time required for recovery of neuromuscular function. A typical dose of neostigmine is 0.03 to 0.07 mg/kg, in conjunction with 0.2 mg glycopyrrolate for every 1 mg of neostigmine.[17]

Cisatracurium should be administered only by adequately trained individuals (ie, anesthesiologist, nurse anesthetist, intensivist, emergency physician) familiar with its actions, characteristics, and hazards. The drug should not be administered without the presence of personnel and facilities for resuscitation, and life support and an antagonist for cisatracurium must be immediately available. Cisatracurium dosing should be individualized, and a peripheral nerve stimulator should be used to measure neuromuscular function during the administration of cisatracurium to monitor the drug's effect. This monitoring will determine the need for additional doses and confirm recovery from neuromuscular block. Cisatracurium has no known effects on consciousness or pain threshold, so to avoid patient distress, a neuromuscular block should not be induced before unconsciousness. This medication is most effective and safest when used with an interprofessional team administering the drug and monitoring the patient.