Generic Name and Formulations:
Cisatracurium besylate 2mg/mL, 10mg/mL (for ICU use only); soln for IV infusion.
Indications for NIMBEX:
As an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU.
See literature. Individualize. Initial dose: 0.15mg/kg or 0.2mg/kg; duration of action with propofol anesthesia: 55 minutes and 61 minutes, respectively. Maintenance: 0.03mg/kg; generally required 40–50 minutes after initial dose of 0.15mg/kg and 50–60 minutes after initial dose of 0.2mg/kg. No adjustment in initial dose necessary when cisatracurium is given shortly after initiation of volatile agents. In long surgical procedures, during enflurane and isoflurane anesthesia, less frequent maintenance dosing or lower maintenance dose may be necessary. Infusion in OR: after initial bolus dose, a diluted solution may be given by continuous infusion during extended surgical procedures. Under opioid/nitrous oxide/oxygen anesthesia: a rate of 1–2mcg/kg/min should be adequate to maintain continuous neuromuscular block. Under isoflurane/enflurane anesthesia: reduce rate by 30–40%. Infusion in ICU: 3mcg/kg/min.
<1month: not recommended. Individualize. 1–23months: initial dose: 0.15mg/kg given over 5–10 seconds during either halothane or opioid anesthesia; duration of action: approx. 43 minutes. 2–12yrs: initial doses: 0.1–0.15mg/kg given over 5–10 seconds during halothane or opioid anesthesia; duration of action: 0.1mg/kg: approx. 28 minutes, 0.15mg/kg: approx. 36 minutes. Infusion in OR: >2yrs: after initial bolus dose, a diluted solution may be given by continuous infusion during extended surgical procedures. Under opioid/nitrous oxide/oxygen anesthesia: a rate of 1–2mcg/kg/min should be adequate to maintain continuous neuromuscular block. Under isoflurane/enflurane anesthesia: reduce rate by 30–40%.
Premature infants (10mL vial contains benzyl alcohol).
To be administered under the supervision of experienced clinicians. Have intubation, artificial respiration, oxygen therapy and reversal agents available. Not recommended for rapid sequence endotracheal intubation. Neuromuscular diseases (eg, myasthenia gravis, myasthenic syndrome). Burn patients. Patients with hemiparesis or paraparesis; neuromuscular monitoring should be performed on non-paretic limb. Acid-base and/or serum electrolyte abnormalities. Be prepared to recognize and treat malignant hyperthermia. ICU: monitor neuromuscular function; if no response elicited, discontinue until response returns. Labor & delivery. Pregnancy (Cat.B). Nursing mothers.
May be potentiated by isoflurane, enflurane, antibiotics (eg, aminoglycosides, tetracyclines, bacitracin, polymyxins, lincomycin, clindamycin, colistin, sodium colistemethate), magnesium salts, lithium, local anesthetics, procainamide, quinidine. May be antagonized by chronically administered phenytoin or carbamazepine.
Nondepolarizing skeletal muscle relaxant.
Bradycardia, hypotension, flushing, bronchospasm, rash, anaphylactic reactions, prolonged neuromuscular block, inadequate neuromuscular block, muscle weakness, myopathy.
Single-dose vial (2mg/mL)—5mL; Single-dose vial (10mg/mL)—20mL; Multi-dose vial (2mg/mL)—10mL (contains benzyl alcohol)