Should we reverse Cis-atracurium

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A colleague was approached and berated for giving a reversal after the patient had received Cis. They had 4 twitches back and it was end of the case. I know the metabolism of Cis and it seems to me that maybe it does not need to be reversed but we were also taught that for medical- legal reasons to always reverse if given a paralytic.

What are the thoughts current standards for reversing Cis? Besides medical-legal reasons is there a reason to reverse Cis? To be honest- I don't have a whole lot of experience with it but just wanted to get some more opinions.

Thanks

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Specializes in CRNA.

This sounds like a classic academic mivacurium debate.

Lawyers aside, TOF alone is a poor indicator for spontaneous muscle movement/recovery from any nondepolarizing agent. It is my practice to reverse most patients that have post tetanic facilitation....especially the fatties. Residual recurarization creates more work for the practitioner and puts the patient at a risk that most likely could have been avoided. Do it right the first time.

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Specializes in SICU, CRNA.

why not? just because cis is eliminated differently doesnt mean it shouldnt be reversed.

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Specializes in Anesthesia.

I am new CRNA and had the debate of who should be reversed and who shouldn't after NDMBs came up the other day with another CRNA. I don't reverse everyone. I use a set of objective criteria( TOF/sustained tetany/time/ASA classification/comorbidities/type of surgery/ability to spontaneous ventilate/adequate TVs/ and redosing NDMB). I don't think we should give any drug just to appease some lawyer, if you think the person needs to be reversed then reverse them, if you can objectively show that patient doesn't need to be reversed don't reverse if that is your professional judgement. It shouldn't matter if it is Cis-Atracurium or not. Cis metabolism just adds another factor into your decision making.

Just my 2cents.

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Specializes in CRNA.

With 4 twitchs, up to 75% of receptors may remain blocked. Research has shown that the biggest problem with this is pharyngeal dysfunction which places the patient at increased risk of aspiration if they should vomit after extubation.

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Specializes in SICU, CRNA.

you may not dose just to appease some lawyer, but that same lawyer is looking for anything, no matter how small or insignificant it is, to screw you six ways to sunday...

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Specializes in Anesthesia.
you may not dose just to appease some lawyer, but that same lawyer is looking for anything, no matter how small or insignificant it is, to screw you six ways to sunday...

There was a survey on another website the other day about something similar to this....Have you actually personally ever known a CRNA to be sued over the lack of using a reversal?

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