cisatracurium (Rx)
Generic: Cisatracurium
Brand: Nimbex
(sis-a-tra-cyoor'ee-um)
Pharmacological Action
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine
Therapeutic outcome: Paralysis of body for administration of anesthesia
Uses
Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation surgery, or general anesthesia
Contraindications
Hypersensitivity
Precautions: Pregnancy B, breastfeeding, children <2 yr, electrolyte imbalances, dehydration, cardiac/neuromuscular/respiratory disease
Dosage & Routes
Adult: IV 0.15 and 0.2 mg/kg depending on desired time to intubate and length of surgery: use peripheral nerve stimulation to evaluate dosage Child 2-12 yr: IV 0.1 mg/kg over 5-10 sec with halothane or opioid anesthesia
Available forms: Inj 2, 10 mg/ml
Implementation - Use nerve stimulator by anesthesiologist to determine neuromuscular blockade - Give anticholinesterase to reverse neuromuscular blockade - Give by slow IV only by qualified person; do not administer IM - Store in light-resistant area - Reassure if communication is difficult during recovery from neuromuscular blockage
Adverse Effects
CV: Bradycardia, tachycardia; increased, decreased B/P
EENT: Increased secretions
INTEG: Rash, flushing, pruritus, urticaria
RESP: Prolonged apnea, bronchospasm, cyanosis, respiratory depression
Pharmacokinetics
Unknown
Pharmacodynamics
Onset 1-3 min, Peak 2-5 min, Duration 30-40 min
Interactions
Individual drugs CarBAMazepine, phenytoin: decreased duration of neuromuscular blockade Isoflurane, lithium: increased neuromuscular blockade
Succinylcholine: decreased neuromuscular blockade
Drug classifications Aminoglycosides, antibiotics (polymix), β-adrenergic blockers, opioids: increased neuromuscular blockade
Nursing Considerations
Assessment - Assess for electrolyte imbalances (K, Mg), may lead to increased action of this product - Assess vital signs (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pattern of respirations; strength of handgrip - Assess • I&O ratio: check for urinary retention, frequency, hesitancy - Assess recovery: decreased paralysis of face, diaphragm, legs, arms, rest of body - Assess allergic reactions: rash, fever, respiratory distress, pruritus; product should be discontinued
Evaluation
Positive therapeutic outcome: Paralysis of jaw, eyelid, head, neck, rest of body
Reference
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