Comment: This study provides interesting information about the pharmacokinetics of cisatracurium, one of the ten isomers of atracurium. Compared with atracurium, cisatracurium is approximately 3.5 times more potent and is associated with less histamine release. The present findings confirm that the pharmacokinetics of cisatracurium are independent of dose after 2 × and 4 × ED95. The data also indicate that the drug primarily undergoes Hofmann elimination. As is the case for the portion of atracurium that undergoes Hofmann elimination, this leads to the formation of laudanosine. However, because it is far more potent and thus involves the injection of considerably fewer molecules, cisatracurium leads to less laudanosine formation.
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Lien et al. (1997) studied this question.