Cisatracurium in intensive care

In a comparative multicentre study in the United States, the neuromuscular-blocking and safety profile of cisatracurium and vecuronium has been evaluated in critically ill, intensive care unit (ICU) patients requiring long-term neuromuscular block (up to 6 days) to facilitate mechanical ventilation. The mean infusion rate of cisatracurium needed to produce sufficient neuromuscular block to facilitate mechanical ventilation was approximately one-third of the mean infusion rate needed for atracurium. The mean time for recovery to a T₄:T₁ ratio of ≥ 0.7 was 60 min (median 50 min) for cisatracurium (as assessed by the twitch response of the adductor pollicis muscle to trains of four numbered stimulations). This value for cisatracurium was similar to that previously reported for atracurium. In contrast, the mean recovery time for vecuronium was over 380 min (median 178 min). Cisatracurium was well tolerated when given as a long-term infusion to critically ill patients; no episodes of seizure or myopathy were observed. One patient given vecuronium experienced prolonged weakness, with myopathy and neuropathy. There was a much lower incidence of prolonged drug effect in patients given cisatracurium than in patients given vecuronium. The neuromuscular-blocking and safety profile of cisatracurium make it a suitable neuromuscolar-blocking drug for use in critically ill patients in the ICU.