Cisatracurium is a non-depolarizing neuromuscular blocking agent belonging to the benzylisoquinolinium class of compounds. It is the cis-cis isomer of atracurium and is designed to provide predictable muscle relaxation with fewer side effects. Cisatracurium acts by competitively blocking acetylcholine at the neuromuscular junction, thereby preventing muscle contraction. It is commonly used as an adjunct to general anesthesia to facilitate endotracheal intubation. The drug is also widely used to provide skeletal muscle relaxation during surgical procedures. Cisatracurium is particularly valuable in critically ill patients because it undergoes Hofmann elimination, an organ-independent metabolic process. This makes it safer for use in patients with hepatic or renal impairment. In intensive care units, it is used to aid mechanical ventilation in patients with acute respiratory distress syndrome. Cisatracurium has minimal histamine release compared to similar agents, reducing cardiovascular adverse effects. Overall, it is a reliable and well-tolerated neuromuscular blocker in anesthesia and critical care practice.
