| Name: |
CISATRACURIUM (NimbexR) |
| Classification: |
non-depolarizing neuromuscular blocker; skeletal muscle relaxant
- used to facilitate mechanical ventilation reduces airway resistance/pressures reduces metabolic rate and O2 consumption used in the management of tetanus
- safe for use in patients with malignant hyperthermia
may be used to stop muscle activity during a seizure but has no anticonvulsant properties |
| Dose: |
- IV Direct:
- IV Infusion:
- 0.03-0.6 mg/kg/hr (equal to 0.5-10 mcg/kg/min)
- dose reduction is not required in either hepatic or renal insufficiency; dose requirements may be increased in patients with severe hepatic disease.
|
| Administration: |
IV Infusion:
2mg/mL (undiluted) in syringe or viaflex bag
- mechanical ventilation must be increased to provide full support prior to administration
|
| Adverse Effects: |
- bradycardia or tachycardia
- hypertension or hypotension
- bronchospasm
- anaphylaxis
- hypothermia
- corneal ulceration
- excessive salivation
|
| Caution: |
- in history of myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis or other neuromuscular disease; respiratory acidosis; hypokalemia; asthma; anaphylactic reactions
|
| Antidote: |
- anticholinesterase agents, e.g. neostigmine
|
| Drug Interactions: |
- cisatracurium + aminoglycosides = increased neuromuscular blocking effect
- cisatracurium + steroids = possible increased risk of myopathy
- cisatracurium + anticonvulsants = possible decreased effect of cisatracurium
|
| Monitoring Therapy: |
- train of four (peripheral nerve stimulator); goal 2-3/4
- HR, ECG
- BP
- ventilator parameters and alarms, chest sounds
- blood gases, Sp02
- electrolytes
- temperature
- eyes - keep moist, patched
- skin/limb support
NOTE:
- Has no CNS effects, therefore, consider patients able to hear and comprehend.
- Has no analgesic or sedative properties; patients require continuous analgesic and sedative administration.
- Pupils and GI tract are not affected.
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in the CCTC providing that the patient is receiving full mechanical ventilation and the loading dose is given by a physician.
- Continuous infusion must be administered via an infusion pump.
- Patient requires placement of an arterial line to monitor BP.
- A bedside sign alerting staff of neuromuscular blocker use must be displayed.
|
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