COMPARISON OF THE VARIABILITY OF RECOVERY PROFILE AND  HEMODYNAMIC EFFECTS OF NEUROMUSCULAR BLOCKADE WITH CISATRACURIUM VERSUS ATRACURIUM

A SIDDIQUI; S RAZA; S SHAFQAT; S ZEHRA; S BOZDAR; MN MUNIR

doi:10.54112/bcsrj.v2024i1.761

Authors

A SIDDIQUI National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
S RAZA Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan
S SHAFQAT Sindh Infection Disease Hospital and Research Centre, DUHS, Karachi, Pakistan
S ZEHRA Tabba Kidney Institute Karachi, Pakistan
S BOZDAR Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan
MN MUNIR Kidney Centre, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.761

Keywords:

tracheal intubation, neuromuscular blocking agent, recovery profile

Abstract

A randomized controlled trial was conducted at the Main Operation Theatre of Jinnah Postgraduate Medical Centre (JPMC) in Karachi to compare the recovery profile and hemodynamic effects of cisatracurium and atracurium among patients undergoing laparoscopic cholecystectomy. The study was conducted from 20th July 2019 to 19th January 2020 and included 68 patients aged between 20 to 50 years undergoing elective laparoscopic cholecystectomy under general anesthesia. Patients with a history of allergy to the study drugs, neuromuscular, pulmonary, renal, or hepatic diseases, smoking, pregnancy, or breastfeeding, and those on preoperative medication such as antipsychotics, aminoglycosides, steroids, or neuroleptics were excluded. The patients were randomly divided into two groups. In Group 1, comprising 34 patients, cisatracurium (0.2 mg/kg) was administered, whereas in Group 2, also with 34 patients, atracurium (0.5 mg/kg) was given. Neuromuscular blocking agents were administered three minutes before intubation. The primary outcomes measured were the recovery profile and hemodynamic effects. In Group 1 (cisatracurium), the baseline mean arterial pressure (MAP) was recorded as 98.40 ± 8.02 mmHg, which increased to 112.20 ± 8.88 mmHg before intubation, resulting in a change of 13.56 ± 5.59 mmHg. In contrast, in Group 2 (atracurium), the baseline MAP was 94.10 ± 7.91 mmHg, which rose to 109.07 ± 8.35 mmHg before intubation, indicating a change of 16.50 ± 4.38 mmHg. The study concluded that cisatracurium is more effective in exhibiting neuromuscular blocking properties than atracurium in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Downloads

Download data is not yet available.

References

Amini, S., Akramifard, A. A., and Roudbari, M. (2011). Comparison of the effects of different doses of cisatracurium on appropriate time for endotracheal intubation and hemodynamic changes during anesthesia. Zahedan Journal of Research in Medical Sciences 13.

Baird, W., and Reid, A. (1967). The neuromuscular blocking properties of a new steroid compound, pancuronium bromide: a pilot study in man. British Journal of Anaesthesia 39, 775-780.

Bartkowski, R. R., Witkowski, T. A., Azad, S., Lessin, J., and Marr, A. (1993). Rocuronium onset of action: a comparison with atracurium and vecuronium. Anesthesia & Analgesia 77, 574-578.

Bergeron, L., Bevan, D. R., Berrill, A., Kahwaji, R., and Varin, F. (2001). Concentration–effect relationship of cisatracurium at three different dose levels in the anesthetized patient. The Journal of the American Society of Anesthesiologists 95, 314-323.

Bluestein, L. S., Stinson, L. W., Lennon, R. L., Quessy, S. N., and Wilson, R. M. (1996). Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Canadian journal of anaesthesia 43, 925-931.

Bowman, W. C. (2013). "Pharmacology of neuromuscular function," Butterworth-Heinemann.

Carroll, M., Mirakhur, R., Lowry, D., Glover, P., and Kerr, C. (1998). A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium. Anaesthesia 53, 744-748.

Elbradie, S. (2004). Neuromuscular efficacy and histamine-release hemodynamic changes produced by rocuronium versus atracurium: a comparative study. J Egypt Natl Canc Inst 16, 107-113.

Foldes, F. F., McNall, P. G., and Borrego-Hinojosa, J. M. (1952). Succinylcholine: a new approach to muscular relaxation in anesthesiology. New England Journal of Medicine 247, 596-600.

Grattan, C., and Marsland, A. (2016). Urticaria: Rook’s Textbook of Dermatology [Internet. Chichester, UK. John Wiley & Sons, Ltd.

MELLINGHOFF, H., RADBRUCH, L., DIEFENBACH, C., and BUZELLO, W. (1997). A Comparison of Cisatracurium and Atracurium: Onset of Neuromuscular Block After Bolus Injection and Recovery After Subsequent Infusion. Survey of Anesthesiology 41, 361-362.

Padmaja, D., and Mantha, S. (2002). Monitoring of neuromuscular junction. Indian Journal of Anaesthesia 46, 279-288.

ShangGuan, W., Lian, Q., Li, J., and Gao, F. (2008). Clinical pharmacology of cisatracurium during nitrous oxide-propofol anesthesia in children. Journal of clinical anesthesia 20, 411-414.

Smith, C., Van Miert, M., Parker, C., and Hunter, J. (1997). A 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 52, 833-841.

Stenlake, J. B., Waigh, R., Urwin, J., Dewar, G. H., and Coker, G. (1983). Atracurium: conception and inception. British Journal of Anaesthesia 55, 3S-10S.

VIBY-MOGENSEN, J., JØRGENSEN, B., and ØRDING, H. (1980). Residual Curarization in the Recovery Room. Survey of Anesthesiology 24, 94.

Yazdanian, F., Ghandi, I., and Toutounchi, Z. (2008). Comparison of hemodynamic effects of atracurium and cisatracurium in patients undergoing coronary artery bypass grafting.