Complete recovery from prolonged cardiac arrest following self-administration of cisatracurium.

We report a case of prolonged cardiac arrest with complete recovery following accidental intravenous (i.v.) self-administration of cisatracurium.The patient had self-administered cisatracurium. Laudanosine, a major metabolic degradation product of cisatracurium, crosses the blood–brain barrier and accumulates in cerebrospinal fluid [3]. Laudanosine, at concentrations comparable to those measured under clinical conditions in cerebrospinal fluid is able to activate alpha4beta2-nicotinic acetylcholine receptors. These receptors are present throughout the nervous system and are involved in chemical signalling. Several studies have suggested that alpha4beta2- nicotinic acetylcholine receptor activation elicits a neuroprotective effect, in vivo and in vitro. Therefore, it has been hypothesized that laudanosine, at clinical concentrations reported, could exhibit potential neuroprotective effects.