Cisatracurium Kabi

Cisatracurium besilate

Muscle relaxant during surgical & other procedures in adults & childn ≥1 mth; for use in adults requiring intensive care; as an adjunct to general anaesth or sedation in the ICU to relax skeletal muscles & to facilitate endotracheal intubation & mechanical ventilation.

IV bolus Endotracheal intubation Adult 0.15 mg/kg. Higher doses will shorten the time to onset of neuromuscular block. Paed patient 1 mth-12 yr 0.15 mg/kg administered rapidly over 5-10 sec. Dose <0.15 mg/kg can be used when cisatracurium is not required for intubation. Maintenance of neuromuscular block Adult 0.03 mg/kg provides approx 20 min additional clinically effective neuromuscular block during opioid or propofol anaesth. Paed patient 2-12 yr 0.02 mg/kg provides approx 9 min additional clinically effective neuromuscular block during halothane anaesth. IV infusion Adult & childn 2-12 yr Initial infusion rate: 3 mcg/kg/min (0.18 mg/kg/hr). Maintenance infusion rate after primary stabilisation period: 1-2 mcg/kg/min (0.06-0.12 mg/kg/hr). IV bolus/infusion ICU Adult Initial infusion rate: 3 mcg/kg/min (0.18 mg/kg/hr).

Hypersensitivity.

Patients w/ known hypersensitivity to other neuromuscular blocking agents; myasthenia gravis & other forms of neuromuscular disease; severe acid-base &/or serum electrolyte abnormalities; history of malignant hyperthermia; burns; patients undergoing surgery w/ induced hypothermia (25-28°C); ICU patients w/ ≥1 medical conditions predisposing to seizures. Hypotonic; must not be applied into the infusion line of blood transfusion. Patient must not drive or operate machines following anaesth w/ cisatracurium. Possible delayed onset of effect in elderly & patients w/ renal impairment. Possible accelerated onset of effect in patients w/ hepatic impairment. Should not be used during pregnancy. Discontinue breast-feeding during treatment & for at least 12 hr after administration of Cisatracurium Kabi. Not recommended in new-born infants <1 mth.

Bradycardia, hypotension.

Increased effect w/ anaesth agents eg, enflurane, isoflurane, halothane & ketamine; other non-depolarising neuromuscular blocking agents; antibiotics (eg, aminoglycosides, polymyxins, spectinomycin, tetracyclines, lincomycin, clindamycin), antiarrhythmics (eg, propranolol, Ca channel blockers, lidocaine, procainamide, quinidine), diuretics (eg, furosemide & possibly thiazides, mannitol, acetazolamide), Mg & lithium salts; ganglion blocking drugs (trimetaphan, hexamethonium). Various antibiotics, β-blockers, antiarrhythmics, antirheumatic drugs, trimetaphan, chlorpromazine, steroids, phenytoin & lithium may aggravate or unmask latent myasthenia gravis or induce a myasthenic syndrome that might lead to increased sensitivity to non-depolarising neuromuscular blocking agents. Administration of suxamethonium to prolong the effects of non-depolarising neuromuscular blocking agents may result in a prolonged & complex block which can be difficult to reverse w/ anticholinesterases. Decreased effect w/ chronic administration of phenytoin or carbamazepine. Treatment w/ anticholinesterase eg, donepezil may shorten the duration & diminish the magnitude of neuromuscular blockade.

Neuromuscular Blocking Agents

M03AC11 - cisatracurium ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.

P₁S₁S₃