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CRITICAL CARE AND TRAUMA

The Pharmacokinetics of Cisatracurium in Patients with Acute Respiratory Distress Syndrome

Gilles Dhonneur, MD, PhD^*, Charles Cerf, MD^*, Franck Lagneau, MD, Jean Mantz, MD, PhD, Catherine Gillotin, PharmD, and Philippe Duvaldestin, MD, PhD^*

*Department of Anaesthesia and Intensive Care Unit, Henri-Mondor Hospital, Creteil, France; Department of Anaesthesia and Intensive Care Unit, Beaujon Hospital, Clichy, France; Department of Anaesthesia and Intensive Care Unit, Bichat Hospital, Paris, France; and Glaxo Wellcome Laboratories, Marly-le-Roi, France

Address correspondence and reprint requests to Philippe Duvaldestin, MD, Department of Anaesthesia and Intensive Care Unit, Henri-Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France. Address e-mail to philippe .duvaldestin{at}hmn.ap-hop-paris.fr

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.

IMPLICATIONS: We studied the pharmacokinetics of cisatracurium in six patients treated for respiratory distress syndrome by continuous muscle relaxation. A deep degree of neuromuscular blockade corresponding to abolition of two responses at the orbicularis oculi to train-of-four stimulation was obtained in all patients. The pharmacokinetic variables observed in these severely ill patients were similar to those of anesthetized patients. No accumulation of laudanosine was seen. Cisatracurium appears to be suitable when continuous muscle relaxation is required in critically ill patients.