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The Pharmacokinetics of Cisatracurium in Patients with Acute Respiratory Distress Syndrome

2001; Lippincott Williams & Wilkins; Volume: 93; Issue: 2 Linguagem: Inglês

10.1097/00000539-200108000-00033

1526-7598

Gilles Dhonneur, Charles Cerf, Franck Lagneau, Jean Mantz, Catherine Gillotin, P. Duvaldestin,

Anesthesia and Pain Management

Continuous neuromuscular blockade is often necessary in patients being treated for acute respiratory distress syndrome (ARDS) to optimize oxygenation. In this study, neuromuscular blockade (no response to two responses at the train-of-four stimulation at the orbicularis oculi muscle) was achieved in six patients with ARDS by a continuous infusion of cisatracurium. The plasma concentration of cisatracurium during the infusion averaged 1.00 (0.25–1.45) μg/mL, expressed as median (range). The clearance and half-life were 6.5 (3.3–7.6) mL · min−1 · kg−1 and 25 (16–48) min, respectively. The laudanosine plasma concentrations were 0.70 (0.12–1.20) μg/mL. The pharmacokinetic variables of cisatracurium are similar to those of patients without organ failure undergoing elective surgery. Plasma laudanosine levels always remained well less that those associated with seizure activity in animal models. Long-term infusion of cisatracurium was not associated with any side effects. Cisatracurium is a suitable muscle relaxant when deep and continuous levels of muscle relaxation are required in patients treated for ARDS.