Sedation, analgesia and paralysis
Cisatracurium (Nimbex) drip
Nimbex
Dosing
| Start | 1–3 mcg/kg/min after a 0.15–0.2 mg/kg bolus |
|---|---|
| Titrate | To train-of-four 1–2 of 4 and the clinical goal |
| Maximum | Usually 1–3; range about 0.5–10 mcg/kg/min |
| Common bags | 200 mg in 200 mL (1 mg/mL); 100 mg in 250 mL (400 mcg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- No sedation or pain relief: deep sedation and analgesia first
- Eye care, skin, DVT prophylaxis, ICU weakness
- Hofmann elimination: fine in liver and kidney failure
Cisatracurium: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- ARDSNeuromuscular blockade and sedation: Paralysis removes dyssynchrony, double-triggering and the large spontaneous efforts that add to transpulmonary pressure (patient self-inflicted lung injury) and lowers oxygen consumption. ACURASYS (Papazian 2010; 340 patients, P/F <150 within 48 h of onset) gave cisatracurium for 48 h: adjusted 90-day hazard ratio for death 0.68 (95% CI 0.48–0.98), crude 90-
- Ventilator Modes and SettingsSevere ARDS: recruitment, proning, paralysis, ECMO: ACURASYS 2010 (n = 340, P/F <150) gave cisatracurium for 48 h and found lower adjusted 90-day mortality (hazard ratio 0.68). ROSE 2019 (n = 1,006, P/F <150 on PEEP ≥8) compared the same regimen with light sedation and stopped for futility: 90-day mortality 42.5% vs 42.8%. ATS 2024 gives a conditional recommendation for neuromuscular blockad
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Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Fentanyl
- Ketamine
- Hydromorphone
- Rocuronium
- Vecuronium
- Pentobarbital
- Remifentanil
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.