Cisatracurium

CjHjBrO, 590-92-1) see Cisatracurium besylate 2-bromopropionitrile (CjH4BrN 19481-82-4) see Lofexidine 2-bromopropionyl bromide... 

C20H25NO4 73074-37-2) see Atracurium besilate (/t)-tetrabydropapaverine 7V-acetyl-L-leucinate (C2gH4(,N207 141109-12-8) see Cisatracurium besylate ( )-tetrabydropapaverine bydrocbloride (C20H26CINO4 6429-04-5) see Cisatracurium besylate [ -( , 5 )]-2,3,4,9-tetrabydro-7V-(l-phenylethyt)-lff-carbazol-3-amine sulfate (1 1)... 

Cisatracurium or atracurium in the presence of renal and/or hepatic dysfunction... 

Up to 30-min time to recovery with an intermediate-acting neuromuscular blocker (i.e., atracurium, cisatracurium, rocuronium, and vecuronium)... 

Agent Tubocuranine Pancuronium Vecuronium Atracurium Rocuronium Cisatracurium Mivacurium Cis-trans isomer Trans-trans isomer C/s-c/s isomer... 

The duration of clinical relaxation with cisatracurium is slightly longer than following equipotent doses of atracurium and ranges from about 35-65 minutes with doses of... 

The major metabolic pathway for cisatracurium is Hofmann elimination, although renal and other organ clearance accounts for some elimination. The pharmacokinetics of cisatracurium are independent of dose in healthy adult patients up to doses of 0.2 mg-kg-1 and its elimination half-life is similar to that of atracurium (Table 6.4). In contrast to atracurium, the clearance of cisatracurium is slightly reduced and recoveiy slightly slower in patients with renal failure. Much less laudanosine is produced as a metabolite of cisatracurium as compared with atracurium even when the drug is given by continuous infusion over a prolonged period of time. 

Cisatracurium can either be administered by repeat dosing or by a continuous infusion (about 2 pg-kg-l-min-1 for a 90% block) for lengthy procedures. 

Atracurium has several stereoisomers, and the potent isomer cisatracurium has become one of the most commonly used muscle relaxants in clinical practice. Although cisatracurium resembles atracurium, it has less dependence on hepatic inactivation, produces less laudanosine, and is less likely to release histamine. From the clinical perspective, cisatracurium has all the advantages of atracurium with fewer side effects. Therefore, cisatracurium has largely replaced atracurium in clinical practice. 

Cisatracurium Similar to tubocurarine Like tubocurarine but lacks histamine release and antimuscarinic effects Prolonged relaxation of surgical procedures relaxation of respiratory muscles to facilitate mechanical ventilation in intensive care unit Not dependent on renal or hepatic function duration, 25-45 min Toxicities Prolonged apnea but less toxic than atracurium... 

Rocuronium Similar to cisatracurium Like cisatracurium but slight antimuscarinic effect Like cisatracurium useful in patients with renal impairment Hepatic metabolism duration, 20-35 min Toxicities Like cisatracurium... 

Kopman AF, Kopman DJ, Ng J, Zank LM. Antagonism of profound cisatracurium and rocuronium block the role of objective assessment of neuromuscular function. J ClinAnesth. 2005 17 30-35. 

---