Neuromuscular Blocking Agent (Non-Depolarising)
Pregnancy: B — crosses placenta minimally
Cisatracurium
Brand names: Nimbex
Adult dose
Dose: Intubation: 0.15–0.2mg/kg IV. Maintenance: 0.03mg/kg boluses or 1–3 micrograms/kg/min infusion. ICU: 0.5–10 micrograms/kg/min
Route: IV
Frequency: Bolus or continuous infusion
Onset 2–3 minutes. Duration 45–75 min. Laudanosine metabolite (CNS stimulant) does not accumulate significantly at clinical doses.
Paediatric dose
Dose: 0.15 mg/kg
Route: IV
Frequency: Intubation dose
Children ≥2 years: same weight-based dosing as adults. Infants <2 years: 0.15mg/kg.
Paediatric weight-based calculator
Children ≥2 years: same weight-based dosing as adults. Infants <2 years: 0.15mg/kg.
Clinical pearls
- Hofmann elimination: degraded spontaneously at physiological pH and temperature — no hepatic/renal metabolism
- Preferred NMB agent in hepatic/renal failure and ICU prolonged infusions
- ACURASYS trial: early cisatracurium infusion in severe ARDS improved 90-day mortality
- Laudanosine (metabolite) is a CNS stimulant — clinically insignificant at standard doses
- Reversal: sugammadex does NOT work — use neostigmine with glycopyrrolate, or wait for spontaneous recovery
Contraindications
- Hypersensitivity to cisatracurium or atracurium
Side effects
- Bradycardia (less than atracurium)
- Prolonged block in hypothermia/acidosis/hypomagnesaemia
- Laudanosine accumulation (extremely high doses in ICU)
Interactions
- Aminoglycosides, clindamycin — potentiate neuromuscular block
- Volatile anaesthetics — potentiate block
- Phenytoin, carbamazepine — resistance to block
Monitoring
- TOF (Train-of-Four) neuromuscular monitoring
- Core temperature (hypothermia potentiates block)
- Serum potassium and magnesium
Reference: BNFc; ACURASYS trial (NEJM 2010); BNF; AAGBI Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators