GasGasGas - Anaesthetic Science for Anaesthesia!

Cisatracurium + other drugs that impair neuromuscular function

Feb 20, 2026
A lively dive into cisatracurium’s identity, potency and why it was developed. Clear breakdowns of its metabolism, Hoffman degradation and safety profile. Comparative discussions on potency and onset versus other neuromuscular blockers. Explains how various drugs and conditions either potentiate or blunt neuromuscular transmission.
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INSIGHT

Cisatracurium: A Potent Atracurium Isomer

  • Cisatracurium is one of ten diastereoisomers of atracurium with three times the potency of the atracurium mixture.
  • It was developed for less histamine release and offers predictable degradation with a stable side-effect profile.
ANECDOTE

Rarely Seen In The UK Fridge

  • Dr Gas Lurks notes cisatracurium's main selling point was minimal histamine release despite limited uptake in UK practice.
  • He recalls seeing cisatracurium only once in a teaching hospital fridge.
ADVICE

Practical Dosing For Cisatracurium

  • Use 0.15 mg·kg as an intubating dose for cisatracurium and consider one-fifth of that as a maintenance infusion.
  • Remember onset speeds up with larger doses and ED95 for cisatracurium is 0.05 mg·kg.
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