Neuromuscular Blocker

Cisatracurium

Benzylisoquinolinium non-depolarizing NMBA · Nimbex

Mechanism: Competitive nicotinic ACh antagonist.

Calculate dose for your patient

Enter weight (kg or lb). Always verify before administration.

Patient weight

Computed weight

70.0 kg · 154.3 lb

Intubation

11 mg – 14 mg

= 5.25–7.00 mL (2 mg/mL)

Organ-independent (Hofmann). Not reversed by sugammadex.

Weight is saved on this device for the next calculator you open.

Full dose calculator

Onset

2–3 min

Duration

30–60 min

Metabolism

Hofmann elimination (organ-independent) → laudanosine.

Dosing

Adult

Intubation: 0.15–0.2 mg/kg. Infusion: 1–3 mcg/kg/min.

Pediatric

0.1–0.15 mg/kg.

Indications

Intubation
Maintenance, esp. in hepatic/renal failure
ICU paralysis (ARDS)

Contraindications

Hypersensitivity

Side Effects

Rare histamine release
Laudanosine accumulation theoretical (high-dose ICU)

Clinical Pearls

1Drug of choice when organ failure precludes hepatic / renal clearance.

2NOT reversed by sugammadex (benzylisoquinolinium).

References & Further Reading

1
Textbook
Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.
2
Textbook
Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.
3
Textbook
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.
4
Textbook
Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.