Title: Cisatracurium in different doses versus Atracurium during general anaesthesia for thyroid surgery: A comparative study
Authors: Dr Arun Kumar Mohanty, Dr Chitta Ranjan Sarangi, Dr Sidharth Sraban Routray, Dr Ayesha Pattnaik
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.17
Abstract
Background & Aim: Cisatracurium, an isomer of atracurium is a non-depolarising neuromuscular blocking drug of intermediate duration. It is devoid of histamine release when compared to atracurium. Both drug are used in liver and kidney failure. However, 2× ED95 dose of cisatracurium may not provide satisfactory intubating condition. The objective of this study was to evaluate the intubating condition, duration of action, hemodynamic effects and any adverse effects of atracurium with different doses of cisatracurium.
Methods: The study was designed as randomized controlled trial in which we compared atracurium (0.5mg/kg) and different doses of cisatracurium (0.1mg/kg and 0.15mg/kg) for intubation. Sixty patients were randomly assigned to one of three groups, group A received 0.5mg/kg of atracurium, group C1 received 0.1mg/kg of cisatracurium, and group C2 received 0.15mg/kg of cisatracurium. Onset time, duration of action, condition of intubation, hemodynamic effects, and signs of histamine release were recorded.
Results: Onset time was found to be significantly lower with group C2 compared to group C1 and group A. At the same time, 0.15mg/kg cisatracurium produced longer duration of action compared to 0.5mg/kg atracurium and 0.1mg/kg cisatracurium.
Conclusion: 0.15mg/kg cisatracurium can provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status without any associated signs of histamine release.
Keywords: Cisatracurium, Atracurium,Hemodynamic , Histamine.
References
- Ali HH, Savarese JJ. Monitoring of neuromuscular function. Anesthesiology 1976; 45: 216-49.
- Barve M, Sharma R. Intubating conditions with Rocuronium br. & Succinylcholine in paediatric patients.Indian J. anaesth. 2002;46 (6) : 465-8 .
- Bartkowski RR, Witknowski TA, Azad S, Lessin J and Marra . Rocuronium onset of action: a comparison with atracurium and vecuronium. Anesthesia & Analgesia.1993; 77(3): 574-8.
- Haines M. Comparison of onset time, duration of action and fade characteristics of atracurium and vecuronium. ANNA J.1993; 61(6): 592-6.
- Yazdanian f.,ghandi i.,toutounchi z., comparison of hemodynamic effects of atracurium and cisatracurium in patients undergoing coronary artery bypass grafting. Journal of iranian society anaesthesiology and intensive care 2008 , Volume 30 , Number 61; Page(s) 56- 66
- Bergeron L, Bevan DR, Berrill A, Kahwaji R, Varin F: Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient. Anesthesiology 95 314-23, 2001.
- Shang Guan, WangNing; Lian, Qing Quan; Li, Jun; Gao, Fang Clinical pharmacology of cisatracurium during nitrous oxide-propofol anesthesia in children. Journal of Clinical Anesthesia 20.6 (2008): 411-4.
- Smith CE, van Miert MM, Parker CJ, Hunter JMA comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1'R-cis isomer of atracurium, with atracurium besylate in healthy patients. Anaesthesia. 1997 Sep;52(9):833-41.)
- Mandal P. Intubating conditions after cisatracurium administration – a dose response study in adults. J anaesth clin pharmacology 2002:18:147-51
- T. Carroll,1 R. K. Mirakhur,1 D. W. Lowry,1 K. C. McCourt1 and C. Kerr2, A comparision of the neuromuscular blocking effects and reversibility 0f cisatracurium and atracurium, Anesthesia 1998,53,page 74
- Suresh S.N. and Singh NG. Comparison between Adductor Pollicis and Orbicularis Oculi as Indicators of Adequacy of Muscle Relaxation for Tracheal Intubation Following Cisatracurium Induced Neurom-uscular Block: Randomized Comparative Clinical Trial.Recent Research in Science and Technology;2010:Vol 2,No 5.
- Mellinghoff H , Radbrush L, Diefenbach C, Buzello W.A comparison of cisatracurium and atracurium :onset of neuromuscular block after bolus injection and recovery after subsequent infusion, Anaesthanalg 1996;83:1072-5.
- Bluestein LS, Stinson LW, Lennon RL, Wilson RM. Evaluation of cisatracurium, anew neuromuscular blocking agent for tracheal intubation. Can J Anaesth.1996;43:925–31.
- El-Kasaby, H. M. Atef, A. M. Helmy, and M. Abo El-Nas, Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgerySaudi J Anaesth. 2010 Sep-Dec;4(3): 152–157.
- Lien CA,Belmont MR,Abalos A.The cardiovascular effects and histamine –releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anaesthesia.Anesthesiol 1995;82:1131-38.
- Basta SJ, Ali HH, Savarese JJ. Clinical pharmacology of atracurium besylate: a new nondepolarizing muscle relaxant. Anesth Analg. 1992;61:723–29.