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Cis-atracurium

Overview

Field Detail
Drug class Neuromuscular blocking agent (NMBA)
Stock vial 5 mg/2.5 mL (2 mg/mL)
Reconstituted conc. N/A (Ready to use)
Storage Refrigerate (2–8°C); Protected from light

Preparation

Before you start

Ensure the vial contains 5 mg/2.5 mL (2 mg/mL). Check expiry and integrity.

Equipment needed

  • 1 × Cis-atracurium 5 mg/2.5 mL vial
  • Normal saline (NS) — for IDT dilutions
  • 1 mL syringes × 3 (for test doses)
  • 25 G needles

Step 1 — Prepare the SPT solution (2 mg/mL — neat)

  1. Draw up 0.5–1 mL of the stock (2 mg/mL) into a 1 mL syringe.
  2. Label: "Cis-atracurium SPT 2 mg/mL".

Step 2 — Prepare IDT dilutions

Prepare in this order, using a fresh syringe for each step.

  1. IDT 0.002 mg/mL (1:1,000):
    • A: Draw 0.1 mL of stock (2 mg/mL) into a 1 mL syringe. Add 0.9 mL NS. Mix. (This is 0.2 mg/mL — 1:10).
    • B: Draw 0.1 mL of A (0.2 mg/mL) into a new 1 mL syringe. Add 0.9 mL NS. Mix. (This is 0.02 mg/mL — 1:100).
    • C: Draw 0.1 mL of B (0.02 mg/mL) into a new 1 mL syringe. Add 0.9 mL NS. Mix. (This is 0.002 mg/mL — 1:1,000).
    • Label: "Cis-atracurium IDT 0.002 mg/mL".

Skin prick test (SPT)

Reagent Concentration
Test solution Neat (2 mg/mL)
Positive control Histamine 10 mg/mL
Negative control Normal saline

Interpretation: Wheal ≥3 mm vs negative control = positive.

Intradermal test (IDT)

Dilution series

Step Dilution Concentration Preparation
1 1:1,000 0.002 mg/mL 0.1 mL of 0.02 mg/mL + 0.9 mL NS

Protocol Change (June 2021)

Cis-atracurium IDT testing is now limited to 1:1,000 (0.002 mg/mL) only to avoid irritant responses.

Inject: 0.05 mL intradermal. Read at 15–20 minutes.