Evaluation of Intubation at 90 and 120 Seconds after 51W89 Administration

Stout, Robert G.; Belmont, Matthew R.; Pavlin, Edward G.; Abalos, Amy; Lien, C.

doi:10.1097/00000542-199409001-01078

Cited by 3 publications

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“…The recommended dose of cisatracurium for adults is 0.15 mg.kg −1 [4, 5]. In a study of adult patients who received cisatracurium 0.15 mg.kg −1 during nitrous oxide–propofol–opioid anaesthesia, the time to maximum effect was 3.4 min while the clinical duration of action was 54.5 min [18].…”

Section: Discussionmentioning

confidence: 99%

“…Cisatracurium is a purified form of one of the 10 stereoisomers of atracurium which, unlike the parent compound, is not associated with dose‐dependent histamine release in humans [1–3]. In adults undergoing nitrous oxide–oxygen–opioid anaesthesia, the effective dose to produce 95% twitch depression (ED 95 ) of cisatracurium is 48–53 μg.kg −1 [2, 3], and a dose of 0.15 mg.kg −1 (≈ 3 × ED 95 ) produces good or excellent intubation conditions within 90–120 s [4, 5]. The relatively high dose requirement of cisatracurium compared with atracurium for tracheal intubation within 2 min (3 × ED 95 vs. 2 × ED 95 ) may be related to the higher potency of cisatracurium, because the latter leads to a slower onset of muscle relaxation [6].…”

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confidence: 99%

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The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

Taivainen¹,

Meakin²,

Meretoja³

et al. 2000

Anaesthesia

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SummaryWe studied the neuromuscular and cardiovascular effects of a single, rapidly administered intravenous dose of cisatracurium 0.15 mg.kg 21 in 27 infants (aged 1±23 months) and 24 children (aged 2± 12.5 years). After midazolam premedication, anaesthesia was induced and maintained with thiopental and alfentanil in addition to nitrous oxide in oxygen. Neuromuscular function was monitored by evoked adductor pollicis electromyography. At least 15 min after intubation, each patient received cisatracurium 0.15 mg.kg 21 over 5 s. Complete neuromuscular blockade was produced by this dose in all but one infant. The mean (SD) onset time of maximal blockade was more rapid in infants Once neuromuscular function started to recover, the rate of recovery was similar in both age groups. Changes in blood pressure and heart rate after the administration of cisatracurium were negligible in both age groups. Cisatracurium, at a dose of 0.15 mg.kg 21 , was effective and well tolerated in infants and children.Keywords Anaesthesia: paediatric. Neuromuscular relaxants: cisatracurium. Pharmacodynamics. Cisatracurium is a purified form of one of the 10 stereoisomers of atracurium which, unlike the parent compound, is not associated with dose-dependent histamine release in humans [1±3]. In adults undergoing nitrous oxide±oxygen±opioid anaesthesia, the effective dose to produce 95% twitch depression (ED 95 ) of cisatracurium is 48±53 mg.kg 21 [2,3], and a dose of 0.15 mg.kg 21 (<3 Â ED 95 ) produces good or excellent intubation conditions within 90±120 s [4,5]. The relatively high dose requirement of cisatracurium compared with atracurium for tracheal intubation within 2 min (3 Â ED 95 vs. 2 Â ED 95 ) may be related to the higher potency of cisatracurium, because the latter leads to a slower onset of muscle relaxation [6].There have been relatively few clinical studies of the use of cisatracurium in children, and the highest dose of cisatracurium that was administered in these studies was 0.1 mg.kg 21 [7±9]. Apart from a case report of an infant given cisatracurium 0.86 mg.kg 21 [10], there is no information on the use of cisatracurium in infants and children aged under 2 years. Accordingly, this study was designed to evaluate and compare the neuromuscular and cardiovascular effects of a single large dose of cisatracurium 0.15 mg.kg 21 in 27 infants and 24 children. Methods

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

Taivainen¹,

Meakin²,

Meretoja³

et al. 2000

Anaesthesia

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“…Intubation conditions following the administration of 2, 3 or 4 × ED 95 of cisatracurium have been evaluated in patients undergoing propofol or propofol–isoflurane anaesthesia [10–12]. In these studies, a dose of cisatracurium 0.15 mg. kg −1 produced good to excellent intubation conditions in nearly all patients within 2 min.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium

et al. 1998

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SummaryThe neuromuscular blocking effects and the reversibility of cisatracurium 0.1 or 0.15 mg.kg ¹1were compared with those of atracurium 0.5 mg.kg ¹1 during anaesthesia with propofol, nitrous oxide and isoflurane. Neuromuscular block was monitored using train-of-four stimulation while recording the mechanomyographic response of the adductor pollicis muscle. The block was either allowed to recover spontaneously or was antagonised with neostigmine 50 mg.kg ¹1 at 10% or 25% recovery of the first twitch of the train-of-four. The median times to maximum block were 2.7, 2.2 and 1.5 min following cisatracurium 0.1 and 0.15 mg.kg ¹1 and atracurium 0.5 mg.kg ¹1 , respectively. After cisatracurium 0.1 mg.kg ¹1 had been given, the median time to recovery of the train-of-four ratio to 0.8 ('adequate recovery') was 74 min during spontaneous recovery, 48 min after reversal with neostigmine when the first twitch of the train-of-four had returned to 10% of control and 50 min after reversal when the first twitch of the train-of-four had returned to 25% of control. These times for cisatracurium 0.15 mg.kg ¹1 and atracurium 0.5 mg.kg ¹1 were 90, 66 and 57 min and 75, 56 and 54 min, respectively. Administration of neostigmine significantly shortened the time to adequate recovery for both drugs but there were no significant differences in the case of either neuromuscular blocking drug between the groups of patients given neostigmine at 10 or 25% recovery of the first twitch of the train-of-four.

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“…Cisatracurium · Atracurium · 51W89 der ersten Studie [26] belegen die Bedeutung des Narkoseverfahrens für die Intubationsbedingungen.…”

Section: Introductionunclassified

Die klinische Pharmakologie von Cisatracurium

Mellinghoff

Diefenbach

1997

Der Anaesthesist

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Cisatracurium (51W89) is one of the ten stereoisomers of atracurium, accounting for about 15% of the racemate. The ED95 of cisatracurium was determined to be about 50 micrograms/kg (cation, molecular weight 929), while the ED95 of atracurium (besylate salt, molecular weight 1245) was 250 micrograms/kg. Thus, on a molar basis in adult patients, cisatracurium is about 3.5 times as potent as the racemic atracurium mixture. We compared atracurium with cisatracurium in healthy adult patients and found an almost identical pharmacodynamic profile. In children, an ED95 of about 40 micrograms/kg was determined, while a 1-min-longer onset of cisatracurium was found in geriatric than in young adult patients. The presence of chronic renal failure did not prolong the duration of action of cisatracurium. The recovery of neuromuscular transmission from a cisatracurium infusion of up to 145 h was investigated in intensive care unit patients. Their time from the end of infusion to a train-of-four ratio > 0.7 (68 +/- 18 min) was on average only some 70% longer than after an infusion of cisatracurium for 2 h in normal surgical patients. In another study, no signs of histamine release nor any clinically relevant cardiovascular effects of cisatracurium were found in doses up to eight times ED95.

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Evaluation of Intubation at 90 and 120 Seconds after 51W89 Administration

Cited by 3 publications

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The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium

Die klinische Pharmakologie von Cisatracurium

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Evaluation of Intubation at 90 and 120 Seconds after 51W89 Administration

Cited by 3 publications

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The safety and efficacy of cisatracurium 0.15 mg.kg−1 during nitrous oxide–opioid anaesthesia in infants and children

The safety and efficacy of cisatracurium 0.15 mg.kg−1 during nitrous oxide–opioid anaesthesia in infants and children

A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium

Die klinische Pharmakologie von Cisatracurium

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The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children