Nondepolarizing NMB
Cisatracurium (and vecuronium)
Nimbex Neuromuscular blocker — fluorescent red Cisatracurium 2 mg/mLVecuronium powder (reconstituted)
Cisatracurium is cleared by Hofmann elimination — useful in liver and kidney failure.
Typical adult doses
| Indication | Dose | Onset | Duration |
|---|---|---|---|
| Cisatracurium intubation | 0.15–0.2 mg/kg IV | 2–3 min | ≈45–60 min |
| Vecuronium intubation | 0.08–0.1 mg/kg IV | 2–3 min | ≈25–40 min |
Mechanism
Competitive nicotinic ACh antagonists (benzylisoquinolinium and aminosteroid).
Key effects
- Paralysis without hemodynamic change
Watch out for
- Sugammadex does NOT reverse cisatracurium; it reverses vecuronium (less avidly than rocuronium)
- Vecuronium accumulates in hepatic/renal failure
Pimp questions
Pimp question
What is Hofmann elimination?
Answer
Spontaneous breakdown at physiologic pH and temperature — independent of liver and kidneys.