Cisatracurium Kabi Special Precautions

Administration: Administer cisatracurium in carefully adjusted dosage by or under the supervision of experienced clinicians who are familiar with the drug’s actions and the possible complications of its use. Facilities for tracheal intubation, and maintenance of pulmonary ventilation and adequate arterial oxygenation should be available.
Malignant hyperthermia: Cisatracurium has not been studied in malignant hyperthermia-susceptible patients. In a study of malignant hyperthermia-susceptible pigs, cisatracurium did not trigger malignant hyperthermia.
Acid-base/electrolyte abnormalities: Acid-base or serum electrolyte abnormalities may potentiate or antagonize the action of cisatracurium.
Intensive Care Unit (ICU) Patients: Seizures reported rarely with other neuromuscular blocking agents (e.g. atracurium) in patients with predisposing factors (e.g. head trauma, cerebral edema, hypoxic encephalopathy, viral encephalitis, uremia) receiving continuous IV infusions for facilitation of mechanical ventilation in intensive care settings. Unclear whether laudanosine (metabolite of atracurium and cisatracurium) contributes to CNS excitation.
Neuromuscular disease: Neuromuscular-blocking agents may have a profound effect in patients with neuromuscular disease (e.g. myasthenia gravis, the myasthenic syndrome). In these and other conditions in which prolonged neuromuscular block is a possibility (e.g. carcinomatosis), the use of a peripheral nerve stimulator and a dose of not more than cisatracurium 0.02 mg/kg is recommended to assess the level of neuromuscular block and to monitor dosage requirement.
Burn patients: Cisatracurium has not been studied in patients with burns; however, based on its structural similarity to atracurium, the possibility of increased dosing requirements and shortened duration of action must be considered if cisatracurium is administered to burn patients.
Hypersensitivity reactions: Caution should be exercised when administering cisatracurium to patients who have shown hypersensitivity to other neuromuscular blocking agents since cross-reactivity between neuromuscular blocking agents has been reported.