The use of cisatracurium for tracheal intubation

We review four studies, two in Europe and two in the United States, in which the safety and efficacy of cisatracurium for tracheal intubation were determined. The studies were designed to closely reflect normal clinical practice in Europe or the United States. The data indicate that optimal intubation conditions are produced 120 s following a dose of 0.15 mg/kg [three times the dose that produces 95% of the maximum effect (ED95)] cisatracurium or 0.2 mg/kg (four times the ED95) after anaesthesia with propofol or thiopentone. If an anaesthetic induction technique which is typical in the United States is used, including intravenous midazolam (1-2 mg), optimal intubation conditions are produced earlier, at 90 s, following a 0.2 mg/kg dose of cisatracurium.