Abstract PR461

Abstract

Background & Objectives: Pancuronium was marketed in 1964. Use of pancuronium is limited in patients with impaired liver and renal function. Atracurium was introduced in 1982. Atracurium besylate slowly loses potency with time at the rate of approximately 6% per year under refrigeration. Rate of loss in potency increases to approximately 5% per month at 25°C. This study was designed to compare the effect of atracurium versus pancuronium on endotracheal intubation after administration of intubating doses on intubating conditions and cardiovascular parameters in Myanmar population. Materials & Methods: Randomized, prospective, comparative, clinical study of sixty patients (30 for Atracurium & 30 for Pancuronium), age between 20-50 years with ASA I and II who underwent elective surgery requiring GA/ IPPV. After induction with propofol 2.5mg kg-1, 30 patients in group A were given atracurium 0.5mg kg-1 intravenously and 30 patients in group B were received pancuronium 0.1mg kg -1. The first intubation attempt was made 3 minutes after administration of the neuromuscular blocking agent. The heart rate and SpO2 changes were recorded every minute from just before injection of neuromuscular blocking agent till 12 minutes. The changes in arterial blood pressure were also recorded every 3 minutes till 12 minutes after injection of NMBA. Intubation conditions were assessed as excellent, good, fair and poor based on jaw relaxation, position of vocal cords, response of the diaphragm to intubation and the grading at the view of laryngoscopy. The times taken for intubation were also recorded. Results: There were no statistically significant differences in pre-operative haemodynamic data. Atracurium provided more jaw relaxations (p=0.026), better laryngoscopic view (p = 0.028), better vocal cord paralysis & better diaphragmatic relaxation (p = 0.038) and better intubating grading (p = 0.028) than pancuronium. Total time taken for intubation was more prolong with pancuronium (p < 0.01). It was concluded that atracurium provided better intubating conditions than pancuronium. Atracurium caused a slight fall in arterial blood pressure from the baseline but it was not statistically significant. Atracurium had lacked hypertensive response to intubation and provided better haemodynamic stability than pancuronium. Pancuronium caused rapid increase and decrease in blood pressure and had hypertensive stress response to intubation at 6 minutes, which was statistically significant (p < 0.05). Pancuronium caused significant increase in heart rate than atracurium, which was statistically significant at every minute. Conclusion: Atracurium provided that better intubating condition and haemodynamic stability than pancuronium. Presented at ANZCA 2016 as ePoster.