Cisatracurium Research Articles

Health Canada warns of potential medication errors with Cisatracurium besilate

Health Canada warns of potential medication errors with Cisatracurium besilate

Comparison of the Effects of Rocuronium Bromide and Cisatracurium Besylate on Intubating Conditions and Haemodynamic Response.

Background General anaesthesia (GA) is predominantly important for conducting tracheal intubation; it should be quick and precise, having a prudent performance. It is preferable to use a neuromuscular blocking drug, which ideally should be highly potent, with a rapid onset and a short duration clinical effect in order to prevent the development of hypoxia during laryngoscopy and tracheal intubation and also avoid any changes in haemodynamics caused by the release of histamine, ganglion block, and anti-muscarinic actions. Thenon-depolarizing muscle relaxants rocuronium and cisatracurium don't have any noticeable independent side effects when used within the recommended dosage levels. Aim The aim was to compare the clinical efficacy of rocuronium bromide and cisatracurium besylate with respect to their property as muscle relaxants in producing favourable intubating conditions and to assess their haemodynamic stability.The objectives of the study were to evaluate the onset of action and any undesirable effects. Methods Between the ages of 20 to 60 years, 60 patients of either gender, divided randomly into groups of 30 each, of American Society of Anesthesiologists(ASA) physical status classification I and II, were put for elective surgical procedures to be done under general anaesthesia. Patients were given 0.6 mg kg-1 IV of rocuronium in Group R and 0.15 mg kg-1 IV of cisatracurium in Group C. After injecting the muscle relaxants, parameters were measured 60, 90, 120, 150, 180, 240, and 300 seconds later. Result Demographical variables like age, gender, and ASA physical status of the two groups were analogous. Group R had good to excellent/favourable intubating conditions by 90 seconds, and Group C by 240 seconds with comparable haemodynamic stability. The onset of action was significantly faster in Group R (92 ± 7.61 seconds) than in Group C (188 ± 40.88 seconds). Conclusion Rocuronium produced favourable intubating conditions having good haemodynamic stability and a statistically significant (p < 0.00001) faster onset of action in comparison to cisatracurium.

Retracted: Facial Nerve Monitoring under Different Levels of Neuromuscular Blockade with Cisatracurium Besilate in Parotid Tumour Surgery.

[This retracts the article DOI: 10.1155/2021/5655061.].

Cisatracurium besylate rescues Mycobacterium Tuberculosis-infected macrophages from necroptosis and enhances the bactericidal effect of isoniazid

ObjectiveTuberculosis is the leading killer among the chronic single-source infectious diseases. Mycobacterium tuberculosis can induce necrotic-dominant multiple modes of cell death in macrophages, which accelerates bacterium dissemination and expands tissue injury in host lungs. Mining drugs to counteract Mycobacterium tuberculosis-induced cell death would be beneficial to tuberculosis patients. MethodsIn this study, the protective drug was screened out from the FDA-approved drug library in Mycobacterium tuberculosis-infected macrophages with CCK-8 assay. The death mode regulated by the drug was identified using transcriptomic sequencing, cytomorphological observation, and in the experimental mouse Mycobacterium tuberculosis-infection model. The functional mechanism was explored using western blot, co-immunoprecipitation, and DARTS assay. The intracellular bacterial survival was detected using colony forming unit assays. ResultsCisatracurium besylate was identified to be highly protective for the viability of macrophages during Mycobacterium tuberculosis infection via inhibiting necroptosis. Cisatracurium besylate prevented RIPK3 to be associated with the executive molecule MLKL for forming the necroptotic complex, resulting in the inhibition of MLKL phosphorylation and pore formation on cell membrane. However, Cisatracurium besylate did not interfere with the association between RIPK3 with its upstream kinase RIPK1 or ZBP1 but regulated RIPK3 autophosphorylation. Moreover, Cisatracurium besylate significantly inhibited the expansion of intracellular Mycobacterium tuberculosis both in vitro and in vivo, which also displayed a strong auxiliary bacteriostatic effect to support the therapeutic efficacy of isoniazid and rifampicin, the first-line anti-tubercular drugs. ConclusionCisatracurium besylate performs anti-Mycobacterium tuberculosis and anti-necroptotic roles, which potentiates its application to be an adjuvant drug for antituberculosis therapy to assist the battle against drug-resistant tuberculosis.

Cistracurium Besylate 10 mg/mL Solution Compounded in a Hospital Pharmacy to Prevent Drug Shortages: A Stability Study Involving Four Degradation Products.

Stability study of a 10 mg/mL injectable cisatracurium solution stored refrigerated in amber glass ampoules for 18 months (M18). 4000 ampoules were aseptically compounded using European Pharmacopoeia (EP)-grade cisatracurium besylate, sterile water for injection, and benzenesulfonic acid. We developed and validated a stability-indicating HPLC-UV method for cisatracurium and laudanosine. At each stability study time point, we recorded the visual aspect, cisatracurium and laudanosine levels, pH, and osmolality. Sterility, bacterial endotoxin content, and non-visible particles in solution were checked after compounding (T0) and after M12 and M18 of storage. We used HPLC-MS/MS to identify the degradation products (DPs). During the study, osmolality remained stable, pH decreased slightly, and the organoleptic properties did not change. The number of non-visible particles remained below the EP's threshold. Sterility was preserved, and bacterial endotoxin level remained below the calculated threshold. Cisatracurium concentration remained within the ±10% acceptance interval for 15 months and then decreased to 88.7% of C0 after M18. The laudanosine generated accounted for less than a fifth of the cisatracurium degradation, and three DPs were generated-identified as EP impurity A, impurities E/F, and impurities N/O. Compounded 10 mg/mL cisatracurium injectable solution is stable for at least 15 months.

Retracted: Comparative Analysis of the Anesthesia Effect of Cisatracurium Besylate and Mivacurium Chloride Otolaryngology Surgery

Retracted: Comparative Analysis of the Anesthesia Effect of Cisatracurium Besylate and Mivacurium Chloride Otolaryngology Surgery

Highly Water-Soluble Cucurbit[8]uril Derivative as a Broad-Spectrum Neuromuscular Block Reversal Agent.

Broad-spectrum agents for the reversal of residual curarization induced by neuromuscular blocking agents are of great significance. Here, we report a highly water-soluble cucurbit[8]uril (CB[8]) derivative as a broad-spectrum neuromuscular block reversal agent induced by both benzylisquinolinium and aminosteroid neuromuscular block agents by the supramolecular sequestration strategy. The UV/Vis competition titration assays suggest the high binding affinity of the CB[8] derivative toward both benzylisquinolinium-type cisatracurium besylate and aminosteroid-type rocuronium, vecuronium, and pancuronium, at the level of 107 M-1. In vivo studies demonstrate that the administration of the CB[8] derivative could significantly accelerate the recovery time compared to the placebo or neostigmine groups. The reversal activity of the CB[8] derivative is comparable to or higher than that of clinically approved sugammadex. Acute toxicity evaluations reveal that the CB[8]-derivative displays outstanding biocompatibility, with the maximum tolerance dose as high as 960 mg kg-1.

A COMPARATIVE STUDY OF ATRACURIUM AND CIS- ATRACURIUM FOR INTUBATING CONDITIONS UNDER GENERAL ANAESTHESIA

Background: Atracurium and Cisatracurium are intermediate-acting nondepolarizing neuromuscular drugs. They both are promising drugs offering a predictable recovery due to non-organ dependent elimination. However, due to the variability in metabolism and narrow therapeutic window, monitoring of neuromuscular functions has signicant importance. Cisatracurium is approximately four times as potent as atracurium. In contrast to Atracurium, Cisatracurium is devoid of chemically mediated histamine release. Routinely atracurium is used for the neuromuscular blockade in most pediatric surgeries. On the other hand, 2 ED95 doses of Cisatracurium do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. Aim: Ÿ To compare the intubating conditions of Atracurium(0.5mg/kg) and Cisatracurium 0.15mg/kg). Ÿ To compare the hemodynamic parameters (MAP, PR, SPO2,) between atracurium and Cisatracurium Ÿ To compare the signs of histamine release potential between atracurium and Cisatracurium. Materials and Methods : A Prospective, observational study was conducted at SRI SIDDHARTHA MEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 74 patients. In Atracurium group, there were 15 patients Results: with ASA grade of 1 and 17 patients with ASA grade of II. In Cis-Atracurium group, there were 15 patients with ASA grade of 1 and 22 patients with ASA grade of II. Chi square test was performed between the 2 groups and p value was observed to be &gt; 0.05 indicating no statistically signicant difference between the groups. Average onset time for Atracurium group was 177 ± 22.4 seconds and same was 184 ± 17.3 seconds in Cis Atracurium group. In Atracurium group, intubation was successful at 1st attempt in 33 subjects, 2nd attempt in 2 subjects, 3rd attempt in 2 subjects. In Cis Atracurium group, intubation was successful at 1st attempt in 35 subjects and 2nd attempt in 2 subjects. In Atracurium group, duration of action of the muscle relaxant was 46 ± 4.9 minutes, Duration of 25% recovery was 33 ± 4.2 minutes, Time of recovery from reversal was 1.7 ± 0.8 minutes. In Cis Atracurium group, duration of action of the muscle relaxant was 68 ± 7.1 minutes, Duration of 25% recovery was 48 ±5.6 minutes, Time of recovery from reversal was 2.2 ± 1.1 minutes. Cis atracurium had longer recovery time and duration of action. Atracurium c Conclusion: aused signicant hemodynamic impact than Cis atracurium. Adverse effects were comparable in both.

Effects of Cisatracurium in Sevoflurane and Propofol Requirements in Dog-Undergoing-Mastectomy Surgery.

The purpose of the present study was to test whether the addition of cisatracurium in combination with propofol and sevoflurane would result in a change in doses of used anesthetic drugs. Ten dogs (Group A) undergoing elective unilateral mastectomy surgery were included in the study. To induce and maintain anesthesia, subjects received propofol and sevoflurane at varying doses; analgesia was performed with remifentanil. After three months, the same subjects (Group B) underwent contralateral mastectomy and received the same anesthetic protocol with the addition of cisatracurium at a dosage of 0.2 mg/kg-1. The following parameters were monitored during anesthesia: heart rate, systolic blood pressure, end-tidal CO2, oxygen saturation, halogenate requirement, and rectal temperature at baseline (T0), induction (T1), 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25), 30 (T30), and 35 (T35) time points. In Group A, halogenate requirement was reduced at all the time points other than T1 (p &lt; 0.001); in Group B, the percentage of halogenate requirement was already reduced at T1 and remained constant during the experimental period, showing no significant intragroup differences. The dose requirements of sevoflurane and propofol varied significantly between the two groups, with significantly lower dosages in the Group B (the cisatracurium-treated group). Moreover, patients treated with cisatracurium showed a stable anesthetic plan. The nondepolarizing-muscle-relaxant cisatracurium besylate could be considered a useful adjunct to anesthetic protocols.

Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients.&#x0D; Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured.&#x0D; Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time.&#x0D; Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.

Comparative Analysis of the Anesthesia Effect of Cisatracurium Besylate and Mivacurium Chloride Otolaryngology Surgery.

Objective The aim is to investigate and compare the anesthesia effect of cisatracurium besylate and mivacurium chloride otolaryngology surgery. Materials and Methods 108 patients who underwent ENT surgery under general anesthesia in our hospital from November 2021 to March 2022 were recruited for retrospective analysis, in which patients in the experimental group A were anesthetized with cisatracurium besylate and patients in the experimental group B were anesthetized with mivacurium, and the anesthetic effects and recovery of the two groups were compared and analyzed. Results There was no significant difference in mean arterial pressure, heart rate, and pulse oximetry levels between the two groups at the six time points of admission, anesthesia induction, intubation, end of operation, recovery of consciousness, and extubation (all P > 0.05). The train of four stimulation values at end of operation, recovery of consciousness, and extubation were significantly higher than those of the experimental group A (all P > 0.05). The recovery time of self-consciousness, extubation time, and eye-opening time of the experimental group B were significantly shorter than those of the experimental group A, and the occurrence of agitation was significantly less than that of the experimental group A (all P > 0.05). The total incidence of adverse conditions in the experimental group B was significantly lower than that in the experimental group A (P > 0.05). Conclusion Compared with cisatracurium besylate in otolaryngology surgery, mivacurium chloride anesthesia offers a promising route with respect to less impact on hemodynamics, faster postoperative recovery, absence of the accumulation of neuromuscular blockade, less adverse reactions, and higher safety.

Comparison of the anesthetic effects of mivacurium and cisatracurium besylate in laser laryngeal microsurgery

Objective: To compare the anesthetic effects of mivacurium and cisatracurium besylate in laser laryngeal microsurgery, and to provide clinical evidence and reference for further optimization of muscle relaxation application. Methods: From October 2021 to January 2022, fifty-six patients of Beijing Tongren Hospital, Capital Medical University, scheduled for laser laryngeal microsurgery with general anesthesia, were enrolled. These patients, aged 18-65 years old, 25 males and 31 females, were divided into two groups (n=28) by random number table method. Cisatracurium besylate group (group C): cisatracurium besylate was injected at 0.1 mg/kg. Normal saline was continuously infused during operation. Mivacurium group (group M):Mivacurium was injected at 0.25 mg/kg and continuously infused at 0.3 mg·kg-1·h-1 during operation.The intubation time, the extubation time, recovery index, Cooper's score, Cormack-Lehane grade, surgical condition grade, postoperative residual neuromuscular block and allergic related adverse events were compared between the two groups. Results: The intubation time and the extubation time of group M were (3.7±1.1) and (16.2±5.0) min, which were statistically significant shorter than those of group C (4.9±0.7) and (26.4±8.6) min (all P<0.05). The recovery indexes of the patients in group M and group C were (4.5±3.4) and (6.2±5.0) min. The Cooper's scores of the two groups were both 9(9, 9). The Cormack-Lehane grades of the two groups were all grade Ⅰ. The number of cases with good/excellent surgical condition grades in group M and group C were 5/23 and 0/28. There were no significant differences in recovery index, Cooper's score, Cormack-Lehane grades and surgical condition grades between the two groups (all P>0.05). The TOF ratio of group M in the post anesthesia care unit (PACU) was (95.7±2.6) %, which was significantly higher than (92.9±3.9) % of group C(P=0.015). There were no significant differences in MAP and HR between the two groups at different time points (all P>0.05). The incidence of skin flushing in group M and group C was 10.7% (3/28) and 0, and the difference was not statistically significant (P=0.074). There were no cases of severe hypotension, significantly elevated airway pressure or airway spasm in both groups. Conclusion: In laser laryngeal microsurgery, compared with cisatracurium besylate, mivacurium has shorter intubation time and extubation time, stable hemodynamics, no significant increase in allergic related adverse events. mivacurium is safe and effective.

Comparison of hemodynamic effects and intubating conditions with two different doses of Cisatracurium in patients undergoing elective surgery under general anaesthesia

Introduction: Cisatracurium, a Benzyl-iso-quinolinium compound is a non-depolarizing muscle relaxant with intermediate duration of action. The ED95 dose of Cisatracurium is 0.04mg/kg (0.032-0.05mg/kg).The intubating dose of a non-depolarizing muscle relaxant drug (NDMD) is 2 times ED95, but for Cisatracurium the recommended intubating dose is 0.15mg/kg which is 3 times ED 95. We did this study to compare the hemodynamic stability and ease of intubation with two different doses of Cisatracurium (0.1mg/kg and 0.15mg/kg) in patients undergoing elective surgery under general anaesthesia with regards to hemodynamic stability, intubating conditions at 3minutes of administration of the drug, requirement of additional dose to provide adequate muscle relaxation, need for drugs to suppress response to laryngoscopy and to check for signs of histamine release. Materials and Methods: 200 patients of the American Society of Anesthesiologists Grade 1 and undergoing elective surgeries under general anesthesia were taken up and divided into two groups of 100 each by computer-generated randomization. Group 1 received Inj. Cisatracurium besylate 0.15 mg/kg IV, Group 2 received Inj. cisatracurium besylate 0.1 mg/kg IV. Results: Both the groups had good to excellent intubating condition after 3 minutes of administration of the study drug.

Clinical study on effect of wrist-ankle acupuncture on incidence of hypertension after intubation during induction of general anesthesia

ABSTRACT Objective To observe the effect of wrist-ankle acupuncture on the incidence of hypertension after tracheal intubation during induction of general anesthesia. Methods 200 patients receiving selective surgery under tracheal intubation and general anesthesia in our Hospital were selected and divided into control group and wrist-ankle acupuncture group using the random number table method, with 100 patients in each group. Sufentanil, cisatracurium besilate, remifentanil, etomidate and lidocaine hydrochloride were used for anesthesia induction, and intravenously injected according to the onset time of drugs, successively. The wrist-ankle acupuncture group was needled in bilateral upper 1, 2 and 3 areas, while the control group was treated with false acupuncture.Blood pressure and related blood biochemical indexes were measured and observed at different stages in each group. Result The incidence of blood pressure exceeding 20% and 30% of basal blood pressure within 5 minutes after intubation was as follows:wrist-ankle acupuncture group 11.83% and 6.45%; control group 29.79% and 22.34%, The incidence in the study group was lower than that in the control group. Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that before induction (P < .05), and plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05). The plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05) Conclusion wrist-ankle acupuncture can prevent hypertension after intubation during anesthesia induction. Moreover, it is safe, effective, minimally invasive. Therefore, it is easy to be popularized in clinical practice.

Pharmacology of Cisatracurium Besylate

Background: In routine anesthesia practice, a variety of neuromuscular blocking agents are used. Cisatracurium besylate is a nondepolarizing neuromuscular blocking agent with an intermediate duration of action. Because of the high molecular weight and polarity, the volume of distribution is small. Cisatracurium besylate undergoes Hofmann elimination, making it an excellent choice for patients suffering from organ failure.&#x0D; Methodology: This review article was prepared after a thorough study of the literature using data search engines such as Scopus, Pubmed, Web of Science, and Google Scholar. This article referred to prior Cisatracurium observational studies and case reports.&#x0D; Review Findings: After learning pharmacology, uses, contraindications of Cisatracurium and reviewing the previous observational studies and case reports about Cisatracurium, this drug is used as a muscle relaxant during general anesthesia for tracheal intubation. It has been used successfully in critical care settings where patients were placed on mechanical ventilation and required complete skeletal muscle paralysis. Systemic or cutaneous release of histamine is not caused by cisatracurium.&#x0D; Conclusion: Cisatracurium is a relatively new intermediate-onset, long-lasting skeletal muscle relaxant. This medication can be used safely in patients with hepatorenal impairment. It, like other muscle relaxants, can be used during elective surgical repair under general anaesthesia as well as in patients undergoing prolonged controlled mechanical ventilation. The only concern could be the cost effectiveness in comparison to other skeletal muscle relaxants on the market.

Cisatracurium besilate enhances the TRAIL-induced apoptosis of gastric cancer cells via p53 signaling

ABSTRACT Cisatracurium besilate is the most commonly used non-depolarizing muscle relaxant in general anesthesia and in intensive care units. Studies have indicated that the proliferation of gastric cancer (GC) cells can be restrained by cisatracurium besilate. The present study aimed to investigate the mechanism underlying the role of cisatracurium besilate in TNF-related apoptosis-inducing ligand (TRAIL)-induced GC. The AGS cell line was exposed to cisatracurium besilate, and then cell viability, colony formation and apoptosis were assessed by performing Cell Counting Kit-8, colony formation, TUNEL and Western blot assays, respectively. Furthermore, the expression levels of p53 and p53 upregulated modulator of apoptosis (PUMA) were measured by Western blotting to determine the effect of cisatracurium besilate on p53/PUMA signaling. After co-treatment with p53 inhibitor, cisatracurium besilate and pifithrin-α/TRAIL, cell apoptosis was detected. Finally, cisatracurium besilate and pifithrin-α were used to co-treat TRAIL-induced AGS cells followed by apoptosis detection. Cisatracurium besilate treatment restrained the proliferation and promoted the apoptosis of AGS cells. Cisatracurium besilate also promoted the expression of p53 and PUMA in AGS cells. Furthermore, TRAIL induced the apoptosis of AGS cells, which was aggravated by cisatracurium besilate treatment. However, pifithrin-α reversed the synergistic effects of cisatracurium besilate and TRAIL on the activities of AGS cells. Therefore, the present study suggested that cisatracurium besilate enhanced the TRAIL-induced apoptosis of GC cells via p53 signaling, and the synergistic effects of cisatracurium besilate and TRAIL may achieve maximal therapeutic efficacy in GC management.

Comparison of three cisatracurium dosing strategies in acute respiratory distress syndrome: A focus on drug utilization and improvement in oxygenation.

PurposeThree continuous dosing strategies of cisatracurium (CIS) for acute respiratory distress syndrome (ARDS) have been described in the literature. After implementation of a ventilator synchrony protocol (VSP), we sought to determine which continuous CIS dosing strategy utilized the least amount of drug without compromising efficacy.MethodsWe retrospectively reviewed patients with ARDS receiving continuous CIS from January 1, 2013 to December 31, 2018. We categorized patients into one of three dosing strategies: fixed dose (FD), titration based solely on train-of-four (TOF), or the VSP. We documented drug consumption and determined efficacy by comparing the change in PaO2/FiO2 ratio (P/F) and oxygenation index (OI) from baseline up to 48 h.ResultsA total of 1047 patients were screened, and 189 met inclusion criteria (VSP = 69, TOF = 99, FD = 21). Drug consumption (mg) was significantly lower in the VSP arm: 415 [IQR 318–528] compared to both the TOF: 665 [IQR 472–927] and the FD arms: 1730 [IQR 1695–1800], p < 0.001 for each. The change in P/F and OI from baseline were statistically equivalent at all time points.ConclusionWithout impacting efficacy of gas exchange, a protocol using ventilator synchrony for CIS titration required significantly less drug compared to TOF-based titration and a fixed dosing regimen.

Comparison between cisatracurium and atracurium during general anaesthesia for abdominal surgery

Background: Neuromuscular blockers (NMB) are very important adjuvant to general anesthesia, Atracurium (benzyl isoquinoline NMB) and cisatracurium besylate (benzyl isoquinoline NMB) are intermediate acting non-depolarizing muscle relaxants. In a prospective randomized study we had compared both drug at a dose of 2xED95 for Atracurium and 6xED95 for Cisatracurium as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects.Method: 60 patients, ASA I&II, 20-60 year old underwent elective abdominal surgerical procedure under general anesthesia (GA) were randomly assigned into 2 equal groups. Group A where 0.5mg/kg atracurium was given and Group C, where 0.3mg/kg cisatracurium was given. Neuromuscular monitoring was done by stimulating ulnar nerve and recording the action potential of adductor pollicis using TOF count. Standardized GA was given to all patients as follows, fentanyl 2mcg/kg, propofol 2mg/kg, followed by NMB agent of corresponding group at designated dose, patient will be ventilated till TOF count reaches 0, intubation was tried by the anaesthesiologist who was blind to the given NMB, intubation was done if the intubating condition was acceptable (excellent or good), and it was re-attempted every 30 sec if it was poor or inadequate. Anesthesia was maintained by N2O, O2 and sevoflurane to a total MAC 1, controlled ventilation was adjusted to normocarbia. Mean arterial blood pressure (MAP), heart rate, and intubating conditions were recorded. Interpretation of TOF count for the onset of action, clinical duration, recovery index was done.Results: Clinically acceptable intubating conditions were achieved after 120 sec more frequently after Cisatracurium (85%) than after atracurium (0%) and after 180 sec Cisatracurium (100%) and atracurium (80%). Cisatacurium had a significant shorter onset time than atracurium (120±30 versus 180±30sec), Atracurium had a significant shorter duration of action than cisatracurium (30±5 versus 60±5min). There were no evidences of any significant clinical cardiovascular changes in both groups. Conclusion: Cisatracurium has a rapid onset of action with good intubating conditions, atracurium has an intermediate duration of action, both are potent and safe with excellent cardiovascular stability.

Comparison between rocuronium and cisatracurium: Efficacy and safety, in patients requiring general anesthesia: A randomized prospective study

Background: Neuromuscular blockers (NMB) are very important adjuvant to general anesthesia, Rocuronium bromide (aminosteroidal NMB) and cisatracurium besylate (benzyl isoquinoline NMB) are intermediate acting non-depolarizing muscle relaxants. In a prospective randomized study we had compared both drug at a dose of 3xED95 for Rocuronium and 6xED95 for Cisatracurium as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects. Method: 60 patients, ASA I&II, 20-60 year old underwent elective surgerical procedure under general anesthesia (GA) were randomly assigned into 2 equal groups. ROC group, where 1mg/kg rocuronium was given and CIS group, where 0.3mg/kg cisatracurium was given. Neuromuscular monitoring was done by stimulating ulnar nerve and recording the action potential of adductor pollicis using TOF count. Standardized GA was given to all patients as follows, fentanyl 2mcg/kg, propofol 2mg/kg,followed by NMB agent of corresponding group at designated dose, patient will be ventilated till TOF count reaches 0, intubation was tried by the anaesthesiologist who was blind to the given NMB, intubation was done if the intubating condition was acceptable (excellent or good), and it was re-attempted every 30 sec if it was poor or inadequate. Anesthesia was maintained by N2O, O2 and sevoflurane to a total MAC 1, controlled ventilation was adjusted to normocarbia. Mean arterial blood pressure (MAP), heart rate, and intubating conditions were recorded. Interpretation of TOF count for the onset of action, clinical duration, recovery index was done. Results: Clinically acceptable intubating conditions were achieved after 60 sec more frequently after rocuronium (80%) than after cisatracurium(0%)and after 90 sec rocuronium (98%)and Cisatracurium(60%). Rocuronium had a significant shorter onset time than cisatracurium (90±30 versus 120±30sec), Rocuronium had a significant shorter duration of action than cisatracurium (35±5 versus 45±5min). There were no evidences of any significant clinical cardiovascular changes in both groups. There were no clinical signs of histamine release in both groups. Conclusion: Rocuronium has a rapid onset of action with good intubating conditions, cisatracurium has an intermediate duration of action, both are potent and safe with excellent cardiovascular stability and without apparent histamine release.

Location matters: Overlooked ethnic-geographic effect in China and Austria on propofol/cisatracurium sex differences among a population pharmacokinetic/pharmacodynamic (PopPK/PD) covariate analysis in men, women, and one transgender subject.

A quick literature search using "sex/gender" vs. the commonly used hypnotic propofol or neuromuscular-blocking agent cisatracurium will reveal numerous contradictory sex difference publications depending on the ethnic-geographic location of where these studies were conducted. We induced anesthesia with cisatracurium besylate (GlaxoSmithKline) 100μgkg-1 administered exactly 1minute following propofol (AstraZeneca) 2mgkg-1 . In 20male and 20 female ethnic Han-Chinese test set patients (Xi'an China), and in similar ethnic white Austrian validation set patients (Graz Austria), we quantified propofol/cisatracurium pharmacodynamic parameters namely propofol onset time, lag time, plasma concentrations (Cp ) at loss-of-behavioral response (LOBR) using bispectral index (BIS); cisatracurium onset time, lag time, and Cp at T1 % (first twitch of train-of-four) complete twitch suppression using mechanomyography (MMG). Serial arterial blood samples were collected for population pharmacokinetic (PopPK) analysis of all demographic and biological covariates (region, sex, age, weight, and height) versus volumes of distribution and clearances pharmacokinetic parameters. In Chinese women (but not in white women), propofol Cp at LOBR was 33.60% lower than men and cisatracurium Cp at T1 % complete twitch suppression was 21.49% lower than men, a clear pharmacodynamic assertion. Region and weight were significant PopPK covariates. We demonstrated that sex differences are influenced by ethnic-geographic location as only in Chinese women (but not in white women) propofol Cp at LOBR and cisatracurium Cp at T1 % complete twitch suppression were lower than in men. When defining sex differences, ethnic-geographic location should be taken into consideration as a predictive factor for optimizing propofol/cisatracurium initial loading recommended dosages.