Cisatracurium Hameln

Indications

Cisatracurium Besylate is a muscle relaxant used in hospital during general anaesthesia. It relaxes the muscles so that a breathing tube can be placed in the windpipe (intubation), so surgery can be carried out more safely, and to help patients on a breathing machine (ventilator) in intensive care. It is used in adults and children as decided by the anaesthetist.

How It Works

Cisatracurium is a non-depolarising neuromuscular blocking agent. It blocks the receptors on muscles that respond to acetylcholine, the chemical nerves use to tell muscles to contract, so the muscles relax and cannot move. It does not cause sleep or relieve pain, so it is always given together with anaesthetic and pain-relief medicines. It breaks down in the blood by itself, largely independent of the liver and kidneys.

Dosage and Administration

Cisatracurium is given only by an anaesthetist or trained critical care doctor, as an injection into a vein or a continuous infusion, with full monitoring and breathing support. The dose depends on body weight, the procedure and the response, and is adjusted using a nerve stimulator. Its effect can be reversed at the end of surgery with medicines such as Neostigmine.

Interactions

• Inhaled anaesthetics, some antibiotics (aminoglycosides such as Gentamicin, Polymyxins, Clindamycin), Magnesium, Lithium, some heart medicines and diuretics can strengthen or prolong its effect.
• Long-term use of Phenytoin or Carbamazepine can reduce its effect.
• The anaesthetist will review all medicines before surgery.

Contraindications

Do not use in people with known allergy to Cisatracurium, Atracurium or benzenesulfonic acid.

Side Effects

• Slow heart rate or low blood pressure
• Skin flushing or rash
• Wheezing (bronchospasm)
• Muscle weakness after long use in intensive care

Severe allergic reactions (anaphylaxis) can occur and are treated immediately by the anaesthetic team. After the operation, tell staff at once if you have difficulty breathing, swallowing or lifting your head.

Pregnancy and Lactation

It should be used in pregnancy only if needed; it is used during caesarean section when the anaesthetist decides it is appropriate. Very little is expected to reach breast milk after a single procedure; ask the doctor about restarting breastfeeding.

Precautions and Warnings

• Given only where equipment for breathing support and resuscitation is available.
• People with myasthenia gravis or other nerve to muscle diseases are very sensitive to it.
• Burns may cause resistance; severe acid-base or salt imbalances can change its effect.
• Tell the anaesthetist about any previous reaction to anaesthetic medicines.

Overdose

Overdose causes prolonged muscle paralysis and inability to breathe unaided. Breathing support is continued until recovery, and reversal medicines are used when appropriate.

Therapeutic Class

Non-depolarising neuromuscular blocking agent (skeletal muscle relaxant used in anaesthesia).

Storage

Hospital medicine. Store as directed on the pack, usually in a refrigerator at 2 to 8°C, protected from light; do not freeze.