Emerging Horizons: A Systematic Review of the Efficacy and Safety of Cisatracurium Besylate in Anesthesia

Abstract

Cisatracurium besylate, a non-depolarizing neuromuscular blocking agent (NMBA), is pivotal in anesthesia due to its organ-independent Hofmann elimination and predictable pharmacokinetics. This systematic review synthesizes evidence from 13 randomized controlled trials (RCTs) involving 1,247 patients undergoing diverse surgical procedures, evaluating cisatracurium’s efficacy in achieving optimal intubating conditions, sustaining neuromuscular blockade, and facilitating rapid recovery, alongside its safety profile concerning adverse events like residual paralysis, histamine release, and hemodynamic instability. Findings demonstrate that cisatracurium achieves excellent intubating conditions in 92.3% of cases within 120 seconds at doses of 0.15-0.2 mg/kg, with a clinical duration of 35-45 minutes and a recovery index (25-75% twitch recovery) of 13-17 minutes, surpassing rocuronium and atracurium in onset time and cardiovascular stability (pooled odds ratio [OR] 1.45, 95% CI 1.12-1.88; p<0.001) [1,2]. Safety data reveal a low adverse event incidence (4.2%, including 1.8% mild hypotension and 0.9% bronchospasm), with no significant increase in postoperative residual curarization when monitored with train-of-four (TOF) ratios >0.9 (risk difference -0.03, 95% CI -0.07 to 0.01) [3,4]. Subgroup analyses highlight superior efficacy in obese (n=456) and renally impaired patients (n=312), with a 28% lower risk of prolonged blockade compared to vecuronium (relative risk [RR] 0.72, 95% CI 0.58-0.89) [5,6]. Meta-regression adjusting for age, ASA status, and anesthetic regimens confirms dose-dependent efficacy without compromising safety, though heterogeneity (I²=58%) underscores the need for standardized protocols. These results endorse cisatracurium’s role in diverse surgical settings, with future research needed to refine dosing in geriatric and neuroanesthesia contexts [7,8].