Title: Comparison of Neuromuscular Blockade and Recovery Characterstics of Cisatracurium Besylate versus Atracurium Besylate in Adult Surgical Patients
Authors: Dr Rochana G Bakhshi, Dr Anisha Nagaria, Dr Shubha N Mohite, Dr Gurlyn Ahluwalia
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.52
Abstract
Aims: To compare neuromuscular blockade and recovery characteristics of cisatracurium and atracurium in adult patients.
Methodology: 60 patients, 18-65 years, ASA class I &II for surgery under general anesthesia were randomly allocated to cis-atracurium and atracurium group. After induction agent, dose of neuromuscular blocking drug (NMBA) atracurium 0.5mg/kg loading and maintenance dose of 0.1mg/kg or cisatracurium ,0.2mg/kg and maintenance dose of 0.03mg/kg was given to the patients.
The onset time was determined as the interval from the end of muscle relaxant injection until “Train of four (TOF) score 0”. Neuromuscular monitoring was carried out at every 15s to stimulate the ulnar nerve via surface electrodes. Duration from the last dose of NMBA to 25% recovery of TOF was recorded.
Results: Mean Duration of action (DOA) of 1ST dose in Cisatracurium group was 61.50 minute which was significantly more as compared to 38.57 minute in Atracurium group. Recovery from last dose in Cisatracurium group was 48.73 minutes, 33.63 minutes in Atracurium group and difference was statistically significant.
Conclusion: Intubating conditions were achieved faster & duration of action was longer with loading dose cisatracurium than atracurium. Between neostigmine administration and attaining a TOF ratio of 80%, time duration was shorter with cisatracurium than atracurium, when administered at TOF 25%.
Keywords: cis-atracurium, atracurium, neuromuscular monitoring.
References
1. Movafeghetal, “Cost analysis and safety comparison of Cisatracurium and Atracurium in patientsundergoing general anesthesia” (European Review for Medical and Pharmacological Sciences; 2013; 17: 447-50)
2. Moore EW, Hunter JM. The new neuromuscular blocking agents: do they offer any advantagesBr.Janaesth 2001; 87: 912-25.
3. Mertes PM, Laxenaire MC. Adverse reactions to neuromuscular blocking agents. Curr Allergy Asthma Rep 2004; 4: 7-16
4. Mohamed Naguib & Cynthia A Lien:pharmacology of muscle relaxants and their antagonists chapter 29, Ronald D. Miller’s Anaesthesia 7th ed.Millers Anaesthesia 7thed Churchill Livingston 2010 Pg.868,869, page876, table 29-6, page 872, table 29-4, 29-7, page 874, page 881 table 29-4, 890
5. T. Taivainen, G. H. Meakin, O. A. Meretoja, K. Wirtavuori, R. J. Perkins,A. K. Murphyetal, The safety and efficacy of cisatracurium 0.15 mg/kg during nitrous oxide±opioid anaesthesia in infants and children, Anaesthesia, 2000, 55, pages 1047-51
6. Lien CA, Belmont MR, Abalos A, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995; 82: 1131-8.
7. Lepage J-Y, Malinovski J-M, Malinge M, et al. Pharmacodynamicdose±response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2-opioid anesthesia. Anesthesia and Analgesia 1996; 83: 823-9.
8. Belmont MR, Lien CA, Quessy S, et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995; 82: 1139-45
9. .Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol.2004;4:26.
10. M. 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. doi: 10.4103/1658-354X.71571)
11. .M. 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 744
12. .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.
13. 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.)
14. Wright PM, Hart P, Lau M et al, cumulative characteristic of atracurium and vecuronium. A simultaneous clinical and pharmacokinetic study. Anaesthesi-ology 81:59-68,1994
15. Train Of Four Monitoring,Critical Care Program HRSRH Developed October, 2006 pg1-13
16. Jorgen Viby Mogensen, Ronald D Miller, Millers Anaesthesia 7th ed Churchill Livingston 2010 Neuromuscular Monitoring chapter 47. page1516-29
17. . Mellinghoff, Hermann MD; Radbruch, Lukas MD; Diefenbach, Christoph MD; Buzello, Walter MD , A Comparison of Cisatracurium and Atracurium: Onset of Neuromuscular Block After Bolus Injection and Recovery After Subsequent Infusion, Anesthesia & Analgesia: November 1996 - Volume 83 - Issue 5 – pg 1072-75
18. 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.
19. 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.
20. 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.
21. Robert K. Stoelting, Simon C.Hiller, Pharmacology & Physiology in Anaesthetic practice 4th edition chapter 8, Philadelphia, (USA): Lippincott Williams and Wilkins; 2006 Neuromuscular blocking drugs pg 210 table 8-2,pg 222-42
22. Basta SJ, Ali HH, Savarese JJ. Clinical pharmacology of atracurium besylate: a new nondepolarizing muscle relaxant. Anesth Analg. 1992;61:723–29.