Drug General Information (ID: DDI1FE3SIC)
Drug Name			Cisatracurium		Drug Info		Nitrous oxide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Neuromuscular Blocking Agents				Respiratory Agents
Structure

Mechanism of Cisatracurium-Nitrous oxide Interaction (Severity Level: Moderate)
Additive neuromuscular blocking effects Click to Show/Hide Mechanism Graph
Drug Name		Cisatracurium				Nitrous oxide
Mechanism		Neuromuscular blocking agent Neuronal acetylcholine receptor  Antagonist				Potentiates neuromuscular blockade
Key Mechanism Factor 1
		Factor Name		Neuronal acetylcholine receptor				Structure Sequence
		Protein Family		Ligand-gated ion channel (TC 1.A.9) family
		Protein Function		After binding acetylcholine, the AChR responds by an extensive change in conformation that affects all subunits and leads to opening of an ion-conducting channel across the plasma membrane.     Click to Show/Hide
Mechanism Description		Additive neuromuscular blocking effects by the combination of Cisatracurium and Nitrous oxide

Recommended Action
Management		The muscle relaxant dosage may need to be reduced when inhalation anesthetics are used, especially during longer procedures. In general, inhalation anesthetics should be administered only by health care providers specially trained in the use of these agents and in the care of anesthetized patients.

References
1	Kronenfeld MA, Thomas SJ, Turndorf H "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology 65 (1986): 93-4. [PMID: 2873764]
2	Mirakhur RK, Ferres CJ, Clarke RS, Bali IM, Dundee JW. Clinical evaluation of Org NC 45. Br J Anaesth. 1983 Feb;55(2):119-24.
3	Withington DE, Donati F, Bevan DR, Varin F "Potentiation of atracurium neuromuscular blockade by enflurane: time-course of effect." Anesth Analg 72 (1991): 469-73