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Minerva Anestesiologica 2015 April;81(4):450-60

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Use of cisatracurium in critical care: a review of the literature

Szakmany T. ^{1, 2}, Woodhouse T. ¹ ✉

¹ Department of Anesthetics, Intensive Care and Pain Medicine, School of Medicine, Cardiff University, Cardiff, UK; ² ACT Directorate, Royal Glamorgan Hospital, Cwm Taf LHB, Llantrisant, UK

Cisatracurium is currently one of the most commonly used neuromuscular blocking agent (NMBA) in intensive care units. Cisatracurium was developed primarily for anaesthetic purposes in order to attempt to resolve some of the problems associated with earlier NMBAs, such as histamine release and laudanosine accumulation. Cisatracurium, the the R-cis-R-cis isomer of atracurium, is up to 5 times more potent than atracurium and so is administered in smaller quantities and produces a lesser degree of laudanosine accumulation in the plasma. In both adult and paediatric settings cisatracurium has favourable pharmacological characteristics compared to vecuronium, a steroid based NMBA often used in critical care. Recent randomised clinical trials suggested that the use of cisatracurium is associated with better outcome in acute respiratory distress syndrome (ARDS). Its use has been associated with better outcomes in therapeutic hypothermia and in traumatic brain injury. Although it has many favorable pharmacological properties, it is more expensive than comparable agents and some safety concerns persist regarding adverse events associated with the drug. The aim of the present study was to perform the first comprehensive review to date of all literature relating to the use of cisatracurium in critically ill patients.