{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T19:46:34Z","timestamp":1778010394515,"version":"3.51.4"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"14","license":[{"start":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:00:00Z","timestamp":1562025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>A case report involving varying cisatracurium dosing requirements in a hyperthermic patient undergoing prone ventilation who subsequently received active cooling as part of targeted temperature management is presented.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>Cisatracurium is known to be primarily metabolized via pH- and temperature-dependent Hofmann elimination. Previous reports in the literature described cases of decreased dosing requirements for both cisatracurium and its parent compound, atracurium, for patients in hypothermic states. While augmented atracurium dosing requirements in hyperthermic states have been reported, a literature search found no such reports concerning cisatracurium administration. In the case described here, a patient was initiated on cisatracurium for treatment of symptoms suggestive of acute respiratory distress syndrome (ARDS) and septic shock. An initial dosing requirement of 12 \u00b5g\/kg\/min (adjusted to a goal of 2\u20134 twitches per train-of-four monitoring) was needed to achieve adequate paralysis while the patient remained hyperthermic (a bladder temperature of 40.1\u00b0C). This cisatracurium infusion rate exceeded maximum reported and maximum institutional infusion rates (10 \u00b5g\/kg\/min). After initiation of cooling and lowering of the bladder temperature to 37.8\u00b0C, the cisatracurium rate requirement decreased to 5 \u00b5g\/kg\/min.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A hyperthermic patient thought to have ARDS and septic shock required a high rate of cisatracurium infusion for adequate paralysis during mechanical ventilation. The cisatracurium did not appear to cause prolonged neuromuscular blockade.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxz098","type":"journal-article","created":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T05:02:52Z","timestamp":1562043772000},"page":"1029-1032","source":"Crossref","is-referenced-by-count":4,"title":["Cisatracurium dosing in a patient with hyperthermia"],"prefix":"10.1093","volume":"76","author":[{"given":"Jin","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Novant Health Presbyterian Medical Center, Charlotte, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Prisma Health Richland, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thai","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Palmetto Health USC Medical Group, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan","family":"Arya","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Palmetto Health USC Medical Group, Columbia, SC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,2]]},"reference":[{"issue":"12","key":"2019070205024630400_CIT0001","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1056\/NEJMoa1005372","article-title":"Neuromuscular blockers in early acute respiratory distress syndrome","volume":"363","author":"Papazian","year":"2010","journal-title":"N Engl J Med."},{"issue":"1","key":"2019070205024630400_CIT0002","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2165\/00003088-199936010-00003","article-title":"Clinical pharmacokinetics of cisatracurium besilate","volume":"36","author":"Kisor","year":"1999","journal-title":"Clin Pharmacokinet."},{"issue":"3","key":"2019070205024630400_CIT0003","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1093\/bja\/76.3.382","article-title":"Comparison of the pharmacodynamics and pharmacokinetics of an infusion of cis-atracurium (51W89) or atracurium in critically ill patients undergoing mechanical ventilation in an intensive therapy unit","volume":"76","author":"Boyd","year":"1996","journal-title":"Br J Anaesth."},{"issue":"9","key":"2019070205024630400_CIT0004","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1111\/j.1365-2044.1997.195-az0331.x","article-title":"A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1\u2019R-cis isomer of atracurium, with atracurium besylate in healthy patients","volume":"52","author":"Smith","year":"1997","journal-title":"Anaesthesia."},{"issue":"2","key":"2019070205024630400_CIT0005","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1093\/bja\/59.2.218","article-title":"Cardiovascular and neurological effects of laudanosine. 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