Introduction
Cisatracurium Hameln IV Infusion 2 mg/ml is a neuromuscular blocking agent used to facilitate intubation and provide muscle relaxation during surgery or mechanical ventilation. It is a stereoisomer of atracurium and belongs to the class of non-depolarizing neuromuscular blockers.
Uses
Cisatracurium is primarily used in surgical procedures to induce muscle relaxation. It is also used in intensive care settings to facilitate mechanical ventilation. It helps to achieve muscle relaxation for endotracheal intubation and during surgical procedures where muscle relaxation is required.
| Brand Name | Cisatracurium Hameln |
|---|---|
| Type | IV Infusion |
| Weight | 2 mg/ml |
| Generic | Cisatracurium Besylate |
| Manufacturer | ZAS Corporation |
| Available in | English বাংলা |
Mechanism of Action
Cisatracurium works by blocking the transmission of nerve impulses to the muscles by antagonizing the neuromuscular junction. It competes with acetylcholine for binding at the motor end plate of the neuromuscular junction, thereby inhibiting muscle contraction.
How Long Does It Take to Work?
The onset of action for Cisatracurium is approximately 2-3 minutes after intravenous administration. The peak effect occurs within 3-5 minutes.
Absorption
Cisatracurium is administered intravenously and is not absorbed through the gastrointestinal tract or other routes of administration.
Route of Elimination
Cisatracurium is primarily eliminated through ester hydrolysis and non-specific plasma esterases. A small portion is metabolized by the liver.
Dosage
Adults: Initial Doses: One of two intubating doses of Cisatracurium may be chosen, based on the desired time to tracheal intubation and the anticipated length of surgery. In addition to the dose of neuromuscular blocking agent, the presence of co-induction agents (e.g., fentanyl and midazolam) and the depth of anesthesia are factors that can influence intubation conditions. Doses of 0.15 (3 × ED95 ) and 0.20 (4 × ED95 ) mg/kg Cisatracurium, as components of a propofol/nitrous oxide/oxygen induction-intubation technique, may produce generally GOOD or EXCELLENT conditions for intubation in 2.0 and 1.5 minutes, respectively. Similar intubation conditions may be expected when these doses of Cisatracurium are administered as components of a thiopental/nitrous oxide/oxygen induction-intubation technique. In two intubation studies using thiopental or propofol and midazolam and fentanyl as co-induction agents, EXCELLENT intubation conditions were most frequently achieved with the 0.2 mg/kg compared to 0.15 mg/kg dose of cisatracurium. The clinically effective durations of action for 0.15 and 0.20 mg/kg Cisatracurium during propofol anesthesia are 55 minutes (range: 44 to 74 minutes) and 61 minutes (range: 41 to 81 minutes), respectively. Lower doses may result in a longer time for the development of satisfactory intubation conditions. Doses up to 8 × ED95 Cisatracurium have been safely administered to healthy adult patients and patients with serious cardiovascular disease. These larger doses are associated with longer clinically effective durations of action.Children: Initial Doses: The recommended dose of Cisatracurium for children 2 to 12 years of age is 0.10-0.15 mg/kg administered over 5 to 10 seconds during either halothane or opioid anesthesia. When administered during stable opioid/nitrous oxide/oxygen anesthesia, 0.10 mg/kg Cisatracurium produces maximum neuromuscular block in an average of 2.8 minutes (range: 1.8 to 6.7 minutes) and clinically effective block for 28 minutes (range: 21 to 38 minutes). When administered during stable opioid/nitrous oxide/oxygen anesthesia, 0.15 mg/kg Cisatracurium produces maximum neuromuscular block in about 3.0 minutes (range: 1.5 to 8.0 minutes) and clinically effective block (time to 25% recovery) for 36 minutes (range: 29 to 46 minutes).
Infants: Initial Doses: The recommended dose of Cisatracurium for intubation of infants 1 month to 23 months is 0.15 mg/kg administered over 5 to 10 seconds during either halothane or opioid anesthesia. When administered during stable opioid/nitrous oxide/oxygen anesthesia, 0.15 mg/kg Cisatracurium produces maximum neuromuscular block in about 2.0 minutes (range: 1.3 to 3.4 minutes) and clinically effective block (time to 25% recovery) for about 43 minutes (range: 34 to 58 minutes).
The dosage of Cisatracurium depends on the surgical procedure and patient characteristics. Typically, the initial dose ranges from 0.1 to 0.2 mg/kg administered intravenously. Maintenance doses may be given as needed based on neuromuscular monitoring.
Administration
Cisatracurium is administered via intravenous injection. Dosage adjustments are made based on clinical response and monitoring of neuromuscular function.
Side Effects
Common side effects include hypotension, flushing, and rash. Rarely, it can cause anaphylactic reactions or prolonged neuromuscular blockade.
Toxicity
Overdose or prolonged use can lead to excessive neuromuscular blockade, respiratory depression, or muscle weakness. Supportive care and reversal agents are used to manage toxicity.
Precautions
Cisatracurium should be used with caution in patients with renal or hepatic impairment, and those with a history of neuromuscular disorders. Monitoring of neuromuscular function is essential during administration.
Interaction
Cisatracurium may interact with other neuromuscular blockers or agents that affect neuromuscular transmission. It is important to monitor interactions when used in conjunction with such drugs.
Disease Interaction
Special precautions are required for patients with liver or kidney dysfunction, myasthenia gravis, or other neuromuscular disorders.
Drug Interaction
Interactions may occur with other neuromuscular blockers, anesthetics, or drugs affecting neuromuscular junctions. Adjustments in dosage may be necessary.
Food Interactions
There are no specific food interactions with Cisatracurium.
Pregnancy Use
Use of Cisatracurium during pregnancy should be based on a risk-benefit assessment. It is categorized as a Category B drug, indicating that it is not expected to be harmful to the fetus based on animal studies.
Lactation Use
The effects of Cisatracurium on breast milk are not well-documented. Caution is advised if the drug is administered to breastfeeding women.
Acute Overdose
Acute overdose can lead to prolonged neuromuscular blockade and respiratory depression. Treatment involves supportive care and the use of neuromuscular reversal agents such as neostigmine or sugammadex.
Contraindication
Cisatracurium is contraindicated in patients with known hypersensitivity to the drug or other neuromuscular blockers.
Use Direction
Follow medical directions for dosage and administration. Continuous monitoring of neuromuscular function is recommended during use.
Storage Conditions
Store Cisatracurium at room temperature, protected from light. Avoid freezing or excessive heat.
Volume of Distribution
The volume of distribution of Cisatracurium is approximately 0.2 to 0.4 L/kg.
Half Life
The elimination half-life of Cisatracurium ranges from 20 to 30 minutes.
Clearance
Cisatracurium clearance is approximately 0.2 to 0.4 L/min, primarily via hydrolysis and non-specific plasma esterases.
See in details version Cisatracurium Hameln IV Infusion 2 mg/ml also Cisatracurium Hameln IV Infusion 2 mg/ml in bangla
