• Neuromuscular blockade as an adjunct in GA to enable intubation or in skeletal muscle relaxation during surgical procedures or mechanical ventilation in ICU settings:
    • In conjunction with propofol or thiopental/ nitrous oxide/oxygen induction technique
    • Induction:
      • Adults and >12 years: Initially IV bolus 0.15-0.2mg/kg
        • Onset: 1.5-2 min
        • Duration: 55-61 min (intermediate-acting)
      • 1-23 months: Initially IV bolus 0.15mg/kg
        • Onset: 2 min
        • Duration: 43 min
      • 2-12 years: Initially IV bolus 0.1-0.15mg/kg
        • Onset: 2.8 min
        • Duration: 28-36 min
    • Intermittent maintenance:
      • IV 0.03mg/kg/dose every 20min PRN
      • To be started 40-60min after 0.15mg/kg induction dose OR 50-60min after 0.2mg/kg induction dose
    • Continuous infusion maintenance:
      • Adults and >2 years: Infuse at 3 mcg/kg/min initially; subsequently reduce rate to 1-2mcg/kg/min to maintain neuromuscular blockade
      • Decrease rate 30-40% if under isoflurane or enflurane anesthesia or 50% if undergoing CABG with induced hypothermia

Injection: 2mg/mL

  • Initial or maintenance bolus dose should be administered undiluted via IV to be pushed over 5-10 sec
  • Should not give alkaline solutions with pH>8.5 in the same line

Non-depolarizing neuromuscular blocker

It binds to the motor end-plate cholinergic receptor thereby antagonizing acetylcholine activity and producing neuromuscular blockade

  • Bradycardia
  • Hypotension
  • Flushing
  • Bronchospasm
  • Rash
  • Hypersensitivity to drug or components
  • Neonates (benzyl alcohol-containing form)

None contraindicated

                          Drug Status

Availability Prescription only
Pregnancy Category B
Breastfeeding Unknown
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Cisatra 10mg/5mL Injection 1’s Themis Medicare Pharma Specialities
Cisatra 20mg/10mL Injection 1’s Themis Medicare Pharma Specialities
Nimbex 2mg/mL Injection 5’s Beta Healthcare Beta Healthcare