A muscle relaxant for anaesthesia
Cisatracurium
An intermediate-acting muscle relaxant given by an anaesthetist that is broken down in the blood, with less flushing than atracurium.
What is Cisatracurium?
Cisatracurium is a muscle relaxant given only by an anaesthetist during a general anaesthetic. It temporarily paralyses the muscles, including the breathing muscles, so a breathing tube can be placed and the muscles stay still for surgery. You are always asleep first and a machine breathes for you throughout. Like atracurium, it is broken down in the blood itself, which makes it useful when the kidneys or liver are not working well, but it is less likely to cause flushing or a drop in blood pressure. The anaesthetist monitors the block and watches for rare reactions such as severe allergy.
Education and reference only. This is a plain-language guide to Cisatracurium — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Cisatracurium is a non-depolarising muscle relaxant used during general anaesthesia. It relaxes the muscles so the anaesthetist can place a breathing tube and keep the muscles still during surgery. It is closely related to atracurium and shares the helpful feature of being broken down in the bloodstream rather than relying on the kidneys or liver. It is given as an injection into a vein by an anaesthetist, only when you are asleep and your breathing is supported by a machine.
How it works
Cisatracurium acts at the junction between nerves and muscles, blocking the signal that makes muscles contract so they relax. Like atracurium, it breaks down spontaneously in the blood (by Hofmann elimination), so it does not depend on the kidneys or liver to wear off, giving a fairly predictable, intermediate duration. A key difference is that it is less likely to release histamine, so it causes less flushing and fewer blood-pressure effects. The block is checked with a nerve monitor while a machine breathes for you.
Company & origin
Originated / developed by: Generic (long-established).
An intermediate-acting muscle relaxant used in the UK by anaesthetists, broken down in the blood and less likely than atracurium to cause flushing.
Practical use
How to take Cisatracurium
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- This medicine is given only by an anaesthetist as an injection into a vein, never taken at home.
- You will always be fully asleep under general anaesthetic before it is given.
- A breathing tube is placed and a machine breathes for you while the muscles are relaxed.
- The anaesthetist monitors the block and lets it wear off or reverses it at the end of surgery.
- Tell your anaesthetist beforehand about any previous reaction to anaesthetics or muscle relaxants.
Weighing it up
Advantages & disadvantages of Cisatracurium
Advantages
- Broken down in the blood itself, so it is useful when the kidneys or liver are not working well.
- Less likely than atracurium to cause flushing or a drop in blood pressure.
- Has a fairly predictable, intermediate duration that does not rely on organ function.
Disadvantages
- Like all muscle relaxants, it can rarely cause a severe allergic reaction.
- It must always be used with a breathing machine and close monitoring by an anaesthetist.
- It is slightly slower to start working than some other relaxants.
Practical use
Good to know
You are always fully asleep before cisatracurium is given, and a machine breathes for you the whole time, so you are never aware of being paralysed. Because it is broken down in the blood itself, it is a good choice for people with kidney or liver problems. Compared with atracurium, cisatracurium is less likely to cause histamine-related flushing, wheeze or a drop in blood pressure, so it is often preferred when a steady blood pressure matters. The block is followed with a nerve monitor and can be reversed at the end. As with all these medicines, malignant hyperthermia and severe allergy are the key emergencies the team watches for.
Who should not take it / use with caution
- People who have had a severe allergic reaction to cisatracurium or similar muscle relaxants should not be given it.
- It is used with care in certain muscle and nerve conditions, guided by the anaesthetist.
- Any decision is made by the anaesthetist after reviewing your health and previous anaesthetics.
Monitoring
- Continuous monitoring of breathing, oxygen, heart rate and blood pressure throughout.
- A nerve monitor is used to check the depth and recovery of muscle relaxation.
- The team watches closely for any sign of a severe allergic reaction.
Side effects
- Most effects are part of the intended muscle relaxation, managed by the anaesthetist.
- A temporary change in heart rate or blood pressure in some people, though less than with atracurium.
- Rarely, a severe allergic reaction, which the team is trained to treat immediately.
Key interactions
- Some antibiotics and other anaesthetic drugs can lengthen or change its effect.
- A reversal medicine can be used at the end to help the block wear off.
- The anaesthetist manages all interactions directly in the operating theatre.
Available as: Injection into a vein, given only by an anaesthetist in hospital.
Answers
Cisatracurium: frequently asked questions
Will I be aware while my muscles are relaxed?
No. You are always fully asleep under general anaesthetic before cisatracurium is given, and a machine breathes for you, so you are not aware of being paralysed.
How is cisatracurium different from atracurium?
Both are broken down in the blood, but cisatracurium is less likely to release histamine, so it causes less flushing and fewer blood-pressure effects.
Why might it be chosen for me?
It is broken down in the blood itself, so it is useful when the kidneys or liver are not working well, and it tends to keep blood pressure more stable.
How is it reversed?
At the end of surgery the block wears off as the drug breaks down in the blood, and a reversal medicine can be used to help; recovery is checked before the tube is removed.
Is it safe?
It is widely used and well understood; the main rare risk is a severe allergic reaction, which the anaesthetic team is trained to recognise and treat immediately.
Authoritative sources
- BNF
- NICE CKS
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