Do cis atracurium have more theoretical risk causing seizure

do cis atracurium have more theoretical risk causing seizure that atracurium as ludanosine implicated in causing seizure is produced by Hoffmann elemination and cis atracurium have 100 percent elemination by this method as compared to atracurium which only 1/3 metabolism by Hoffmann

Cisatracurium and atracurium are both neuromuscular blocking agents used during anesthesia to induce muscle relaxation. The theoretical risk of causing seizures, particularly due to the production of laudanosine, is associated with atracurium, not cisatracurium.


  • Atracurium is metabolized in the body via the Hofmann elimination process, leading to the formation of laudanosine, a metabolite implicated in causing seizures.
  • Laudanosine is believed to have potential neuroexcitatory effects and has been associated with seizures, especially at high concentrations or prolonged infusions.


  • Cisatracurium, on the other hand, is one of the isomers of atracurium and is considered a more purified form. It undergoes Hofmann elimination like atracurium, but it does not produce laudanosine.
  • Due to its lower propensity to produce laudanosine, cisatracurium is often considered to have a lower theoretical risk of causing seizures compared to atracurium.

In summary, while both atracurium and cisatracurium undergo Hofmann elimination, only atracurium produces laudanosine, which has been associated with the theoretical risk of causing seizures. Cisatracurium is often preferred when there is concern about the potential neuroexcitatory effects associated with laudanosine. However, any use of neuromuscular blocking agents should be carefully considered based on the patient’s specific needs, overall health, and anesthetic plan, and it should be administered under appropriate medical supervision.