Cisatracurium

How it works

It is a single isomer of atracurium that competitively blocks acetylcholine at nicotinic receptors of the neuromuscular junction, preventing end-plate depolarisation and producing paralysis.

Prescribing in practice

• It produces complete respiratory paralysis and must only be used where airway control and mechanical ventilation can be maintained by experienced clinicians.
• Like atracurium it is eliminated by organ-independent Hofmann degradation, making it suitable in renal or hepatic impairment, but it causes less histamine release.
• It has no sedative or analgesic properties, so adequate anaesthesia must be ensured to avoid awareness during paralysis.

Monitoring

Monitor neuromuscular function with a peripheral nerve stimulator and confirm recovery before extubation.

Counselling the patient

• Remind the team that the patient is fully dependent on ventilation while paralysed.
• Ensure sedation and analgesia are titrated alongside the block.

Evidence & guidelines

Its use reflects established anaesthetic and critical-care practice, with neuromuscular monitoring recommended by professional anaesthetic guidance.