||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
Table 1. Indications and Dosing of Neuromuscular Blockers (NMB’s)
|Single dose for procedure, mechanical ventilation or hypothermia
(round to nearest 10 mg)
Continuous infusion for hypothermia or mechanical ventilation
Continuous infusion for severe ARDS
||15 mg bolus followed by 37.5 mg/hr x 48 hours then stop or convert to rocuronium as required
- IV Direct:
- IV Infusion:
- 0.03-0.6 mg/kg/hr (equal to 0.5-10 mcg/kg/min)
Cisatracurium 15 mg IV bolus, then 37.5 mg/hour IV continuous
infusion for 48 hours. Do not titrate.
- dose reduction is not required in either hepatic or renal insufficiency; dose requirements may be increased in patients with severe hepatic disease.
2mg/mL (undiluted) in syringe or viaflex bag
- mechanical ventilation must be increased to provide full support prior to administration
- bradycardia or tachycardia
- hypertension or hypotension
- corneal ulceration
- excessive salivation
- in history of myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis or other neuromuscular disease; respiratory acidosis; hypokalemia; asthma; anaphylactic reactions
- anticholinesterase agents, e.g. neostigmine
- cisatracurium + aminoglycosides = increased neuromuscular blocking effect
- cisatracurium + steroids = possible increased risk of myopathy
- cisatracurium + anticonvulsants = possible decreased effect of cisatracurium
- 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.
- May be administered by IV infusion or IV direct by an approved nurse in the CCTC providing that the patient is receiving full mechanical ventilation.
- An approved RN in CCTC may administer the initial dose.
- Administration of analgesics and sedatives must precede initiation of neuromuscular blocking agents.
- A continuous infusion of analgesics and sedatives must be administered with an infusion of neuromuscular blocking agents.
- 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