Cisatracurium Group Research Articles

Comparison of Postoperative Muscle Strength Recovery Between Cisatracurium and Rocuronium.

Background Neuromuscular blocking agents are crucial for anesthesia but can cause reversible paralysis, leading to risks like postoperative residual dysfunction. Undetected paralysis in thepost-anesthesia care unit (PACU) jeopardizes patient safety by impairing airway function and increasing complications. Effective reversal, assessed clinically or via nerve stimulation, is critical to prevent residual postoperative curarization (RPOC), which is linked to significant morbidity and mortality. Evaluating agents like rocuronium and cisatracurium helps optimize anesthesia outcomes and patient recovery. Methodology The study included 100American Society of Anaesthesiologists (ASA) I and II patients approved by the Institutional Review Board of Kasturba Medical College, Mangalore, India. Patients were briefed about the study, provided written informed consent, and underwent pre-anesthetic evaluations, including discussions on anesthetic procedures and associated risks. They were instructed to fast overnight after consenting. Results The study compared 100 ASA I and II patients receiving rocuronium or cisatracurium during anesthesia, analyzing age distribution (p=0.429), gender (p=0.839), ASA status (p=0.228), and physical characteristics (height, weight, BMI, p>0.05). Recovery parameters such as hand grip, sustained head lift, and double burst stimulation (DBS) twitch response showed no significant differences between groups (p=0.538 for hand grip and sustained head lift; p=0.220 for DBS. Late recovery rates at 15 minutes were observed with 16% for hand grip, 14% for sustained head lift, and 26% for DBS in the rocuronium group; compared to 14%, 10%, and 16%, respectively, in the cisatracurium group. Conclusion The study found significant postoperative residual curarization in both groups, emphasizing the need for intraoperative and PACU peripheral nerve stimulation for effective assessment. Further research on intraoperative variables could improve understanding of residual paralysis in PACU, guiding better anesthesia management.

Atracurium versus cisatracurium: A comparison of efficacy and safety of intubating dose in adult surgical patients

Abstract Background: Our study investigated and compared the properties of atracurium and cisatracurium, nondepolarizing neuromuscular blocking agents from the benzylisoquinolinium group. Both of these agents exhibit an intermediate duration of action. We studied the onset of neuromuscular blockade, intubating conditions, hemodynamic stability, and recovery following intubating doses. Materials and Methods: We conducted a study involving 40 patients undergoing general anesthesia, randomly assigned to two groups. Group A, consisting of 20 patients, received a dose of 0.6 mg/kg of atracurium, while Group C, also with 20 patients, received 0.15 mg/kg of cisatracurium. Throughout the surgery, we observed and recorded the time of onset of neuromuscular blockade, the intubating conditions, and the recovery following the administration of the first dose of neuromuscular blocking agents. Additionally, we continuously monitored the patient’s hemodynamic status until they recovered from the initial dose. Results: Group C exhibited a significantly faster onset of action (231.5 ± 31.2 s) than Group A (291.0 ± 14.1 s) for the administered neuromuscular blocking agents. The recovery duration following the intubating dose was notably shorter in Group A (31 ± 6.20 min) compared to Group C (50.5 ± 3.20 min). Additionally, in the cisatracurium group, all patients (100%) achieved “excellent” intubating conditions, whereas in the atracurium group, this was only the case for 60% of patients, and this difference was statistically significant. Furthermore, the atracurium group showed significantly higher heart rate and mean arterial pressure readings at different intervals than the cisatracurium group. Importantly, no adverse reactions were observed in any of the patients throughout the study. Conclusion: Compared to atracurium (0.6 mg/kg), cisatracurium at a dose of 0.15 mg/kg demonstrates superior effectiveness regarding the onset and duration of neuromuscular blockade and intubating conditions. Furthermore, cisatracurium offers a more favorable hemodynamic profile.

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 > 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.

A clinical comparative study to evaluate the efficacy of intubating doses of atracurium and cisatracurium in patients undergoing general anesthesia

Background: Skeletal muscle relaxation is integral part of general anesthesia. Non-depolarizing neuromuscular blocking drugs like cisatracurium are devoid of any signs of histamine release and can improve the quality of intubating conditions. Aims and Objectives: We decided to assess the efficacy of Cisatracurium when compared to atracurium in terms of intubating conditions and hemodynamic parameters in patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 80 patients in the age group of 20–65 years were randomly allocated into Group A received Atracuruium 0.5 mg/kg and Group B received Cisatracurium 0.15 mg/kg for intubation after administration of induction agent. Intuabating conditions were assessed by Cooper et al., score and hemodynamic parameters such as heart rate and blood pressure were recorded at 1, 3, 5, 10, 15, and 30 min of intubation. Any signs of histamine release were noted. Results: Demographic profile was comparable between the two groups. As per Cooper et al., score intubating conditions were excellent with Cisatracurium group as compared to the atracurium group which was statistically significant. Hemodynamic parameters during intubation and after intubation were comparable between two groups. No associated signs of histamine release were noted in either of the groups. Conclusion: From our clinical comparative study, we have observed that Cisatracurium 0.15 mg/kg provides better intubating conditions and stable hemodynamic profile with no signs of histamine release as compared to atracurium 0.5 mg/kg dose.

Comparison of rapid intubating conditions between rocuronium and cisatracurium

Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6× ED95) versus 1.2 mg/kg rocuronium (4× ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4× ED95) or 0.3 mg/kg cisatracurium (6× ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ 2 test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects.

Application of Mivacurium in Fast-Track Anesthesia for Transthoracic Device Closure of Ventricular Septal Defects in Children.

IntroductionThe objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children.MethodsThe data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used.ResultsNo statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05).ConclusionIt is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.

English

BACKGROUND Cisatracurium and atracurium are intermediate acting muscle relaxants which do not depend on renal or hepatic metabolism for elimination since they undergo Hofmann elimination. Despite the advantages of cisatracurium such as minimal effects on the cardiovascular system, no accumulative effects, no metabolite toxicity, and metabolic product has no neuromuscular blocking effects, due to slow onset and unsatisfactory intubating conditions, the use of cisatracurium is limited compared with those seen with equipotent doses of other neuromuscular blocking agents. This study was undertaken to find onset time and intubating conditions with 3 × ED95 doses of atracurium versus cisatracurium. METHODS ASA grade 1 or 2 patients, (N = 220) were randomly allocated into 2 groups to receive equipotent doses of either atracurium or cisatracurium. Intubating conditions were assessed using Cooper et al scale and neuromuscular monitoring done using TOF Watch SX. Haemodynamic responses and any adverse effects were noted. RESULTS The onset time was 167.36 ± 75.41 seconds (2.78 ± 1.25 minutes) in atracurium group whereas in cisatracurium group, onset time was 249.26 ± 75.90 seconds (4.15 ± 1.26) and the difference was statistically significant with p value of &lt; 0.001. The difference in intubating conditions between the groups was statistically insignificant. However, atracurium produced a higher incidence of clinically acceptable conditions (excellent in 94.4 %) than cisatracurium (excellent in 87.3 %). The incidence of adverse effects such as erythema, flushing and bronchospasm was greater in Atracurium group though hypotension was observed in both groups. CONCLUSIONS Onset time and intubating conditions are significantly better with equipotent doses of atracurium compared to cisatracurium. But atracurium is associated with higher incidence of adverse effects such as erythema, flushing and bronchospasm, though the potential of cisatracurium to cause anaphylactoid reactions cannot be ignored. KEYWORDS Cisatracurium, Atracurium, Muscle Relaxants, Neuromuscular Blocking Agents, Erythema, Flushing, Bronchospasm, Hypotension, Anaphylactoid Reactions

Cisatracurium Versus Atracurium for Abdominal Surgeries Regarding Condition of Intubation and Hemodynamic Effect

Abstract Background: Neuromuscular-blocking drugs block neuromuscular transmission, causing paralysis of the affected skeletal muscles. In clinical use, neuromuscular block is used adjunctively to anesthesia to produce paralysis, first to paralyze the vocal cords, and permit intubation of the trachea, and second to optimize the surgical field by inhibiting spontaneous ventilation, and causing relaxation of skeletal muscles. Patients and Methods: This was a prospective, randomized study registered in Clinical Trials Registry of India (CTRI/2019/04/018580). We included 100 patients divided into two groups of 50 each. Group A received atracurium (0.5 mg/kg), whereas Group B received cisatracurium (0.15 mg/kg). Efficacy of both the drugs was compared in terms of onset of action, duration of action, duration of recovery, hemodynamic conditions during and after intubation, and signs of histamine release in both the drugs. Results: Mean duration of 25% recovery from the reversal in the atracurium group was 32.4 ± 1.90 min which was significantly less as compared to 49.46 ± 1.86 min of cisatracurium group (P &lt; 0.001). The mean duration of recovery from the reversal in cisatracurium group was 2.18 ± 0.82 min which was significantly more as compared to 1.8 ± 0.75 min of atracurium group (P = 0.02). Conclusion: Cisatracurium in a dose of 0.15 mg/kg had a faster onset and duration of action than atracurium 0.5 mg/kg. At this dose, cisatracurium provides optimal intubating condition, rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, no signs of histamine release clinically, and without any residual muscle paralysis compared to atracurium.

Comparison of hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in electroconvulsive therapy.

Background:Electroconvulsive therapy (ECT) is nowadays used commonly as one the most effective treatment methods in psychiatric disorders. In patients undergoing ECT, succinylcholine is usually used. In addition, cisatracurium is occasionally used on a case report basis globally. In this study, we compared the hemodynamic changes and serum potassium levels in the use of succinylcholine and cisatracurium in ECT.Materials and Methods:The current crossover clinical trial was performed on 45 patients who were candidates for ECT between 2017 and 2018. The patients were given succinylcholine or cisatracurium randomly on two separate occasions of ECT. The independent t-test and Chi square Test were used to compare the data.Results:Comparison of mean systolic blood pressure (P = 0.14), diastolic blood pressure (P = 0.33), and mean arterial pressure (P = 0.23) did not show any significant difference between the two groups. The induced seizure duration (P = 0.002), return of spontaneous respiratory from seizure ending (P = 0.001), and apnea duration (P = 0.01) were significantly higher in the cisatracurium group compared to the succinylcholine group. However, the frequency of tachycardia in cisatracurium group was lower than the succinylcholine group (P < 0.001). In addition, the serum potassium level had a significant difference (P < 0.001) between the two groups.Conclusion:Using cisatracurium can be an alternative to succinylcholine during ECT since it causes less elevation in serum potassium and creates a longer duration of induced seizure, more rapid re emergence of spontaneous breathing at the end of seizure (P = 0.001), and a lower prevalence of tachycardia compared to succinylcholine (P < 0.001).

EFFICACY OF ATRACURIUM VERSUS CISATRACURIUM IN PATIENTS UNDERGOING RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURE UNDER GENERAL ANAESTHESIA – A COMPARATIVE STUDY

Objectives: The objectives of the study were to compare the efficacy of injection atracurium 0.5 mg/kg intravenous (IV) versus injection cisatracurium 0.2 mg/kg IV for intubation in patients undergoing endoscopic retrograde cholangiopancreatography procedure (ERCP).&#x0D; Methods: Hundred adult patients of both sexes in the age group of 18–60 years belonging to the American Society of Anesthesiologists I/II category posted for ERCP procedures under general anesthesia were randomly allocated into two groups of 50 each. Group A received injection atracurium besylate 0.5 mg/kg intravenously and Group B received injection cisatracurium besylate 0.2 mg/kg intravenously. Parameters observed were time to the maximum blockade, intubating condition, time required for intubation, duration of action, hemodynamic parameters during intubation, and after 1, 2, 3, 5, and 15 min and any adverse effects.&#x0D; Results: Demographic profile was comparable between the groups. Intubating condition as per Cooper et al. score was excellent in 36 patients in cisatracurium group as compared to 19 patients in atracurium group. The overall intubating condition was found to be better in Group B (p=0.00001). Time to the maximum blockade was significantly high with atracurium as compared to cisatracurium. The mean of intubation time was less with cisatracurium (135±11.1) than that of atracurium (144±9.48) in seconds, which was statistically significant. Duration of neuromuscular blockade was found to be prolonged in Group B as compared to Group A (p=0.000). Hemodynamic parameters during intubation and after 1, 2, 3, 5, and 15 min were comparable between the groups. No adverse effect was seen in both groups.&#x0D; Conclusion: Cisatracurium 0.2 mg/kg provides excellent intubating conditions with rapid onset of action, longer duration of action, and no significant hemodynamic changes as compared with atracurium 0.5 mg/kg for ERCP procedures without any adverse effects.

Neuromuscular blockade in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials

BackgroundNeuromuscular blocking agent (NMBA) has been proposed by medical guidelines for early severe acute respiratory distress syndrome (ARDS) because of its survival benefits. However, new studies have provided evidence contradicting these results.MethodA search was performed of the Pubmed, Scopus, Clinicaltrials.gov, and Virtual Health Library databases for randomized controlled trials (RCT) evaluating 28-day mortality in ARDS patients treated with NMBA within 48 h. An English language restriction was applied. Relevant data were extracted and pooled into risk ratios (RR), mean differences (MD), and corresponding 95% confidence intervals (CI) using random-effect model. Sensitivity and meta-regression analysis were performed.ResultsFrom 2675 studies, we included five RCTs in the analysis, for a total of 1461 patients with a mean PaO2/FIO2 of 104 ± 35 mmHg. The cisatracurium group had the same risk of death at 28 days (RR, 0.90; 95% CI, 0.78–1.03; I2 = 50%, p = 0.12) and 90 days (RR, 0.81; 95% CI, 0.62–1.06; I2 = 56%, p = 0.06) as the control group (no cisatracurium). The secondary outcomes of mechanical ventilation duration and ventilator-free days were not different between the two groups. Cisatracurium had a significantly lower risk of barotrauma than the control group with no difference in intensive care unit (ICU)–induced weakness. The PaO2/FIO2 ratio was higher in the cisatracurium group but not until 48 h. Meta-regression analysis of the baseline PaO2/FIO2 ratio, positive end-expiratory pressure (PEEP) revealed no heterogeneity. Subgroup analysis excluding the trial using high PEEP and light sedation strategy yielded an improvement in all mortality outcomes.ConclusionNMBA improves oxygenation only after 48 h in moderate, severe ARDS patients and has a lower barotrauma risk without affecting ICU weakness. However, NMBA does not reduce ventilator-free days, duration of mechanical ventilation or, most importantly, the mortality risk regardless of the severity of ARDS.

A Comparative Study of Atracurium and Cisatracurium in paediatric cleft Lip and Cleft palate surgeries

General anaesthesia with intubation with RAE tube is preferred in children undergoing cleft lip and palate surgeries. Neuromuscular blocking drugs (NMBDs), are given to infants and children to attain ideal intubating conditions by providing adequate muscle relaxation. In contrast to routinely used atracurium, cisatracurium is comparatively a newer drug with lesser histamine release. The study was designed with the aim to compare the efficacy of atracurium (2×ED95) and cisatracurium (4×ED95).90 patients, 6 months-5 years, ASA class I &II were randomly allocated to cisatracurium and atracurium group. After administration of induction agent, dose of neuromuscular blocking drug atracurium 0.5mg/kg or cisatracurium 0.2mg/kg was given to the patients. The intubating conditions were graded using ‘Cooper et al’ scoring system. Neuromuscular blockade was assesed using train of four ratio. Alongwith intubating conditions, onset and duration of action, hemodynamic effects, and signs of histamine release were measured in both the groups. In the atracurium group the mean score according to ‘Cooper et al'scale was 6.86±0.54, whereas in the cisatracurium group it was 8.12±0.64, the difference between the groups was statistically significant. Time of onset was found to be 2.7±0.12 minutes in the cisatracurium group and 3.28±0.64 minutes in the atracurium group. Duration of action was 64.6±6.18minutes in the cisatracurium group as compared to 35.4±4.64minutes in the atracurium group. Cisatracurium(0.2mg/kg) is more efficacious as compared to atracurium(0.5mg/kg)with respect to intubating conditions, it has a faster onset of action, good intraoperative hemodynamic parameters, longer duration of action with no side effects.

Clinical profile comparison of cisatracurium and rocuronium in elective surgery

Background: Most surgeries are carried out with ease using neuromuscular blocking agents. This study was aimed to compare the intubating dose of cisatracurium and rocuronium regarding the onset of action, clinical duration, recovery index, intubating conditions, efficacy, and safety in elective surgery. Method: 60 adult patients of American Society Anesthesiology (ASA) grade I & II, underwent elective laparoscopic surgery were randomized to receive either cisatracurium 0.1 mg/kg (Group C) or rocuronium 0.6 mg/kg (Group R). Neuromuscular monitoring was done using STIMPOD Xavant NMS450. Relaxogram interpretation was carried out for the onset of action, clinical duration, and recovery index. Results: Cisatracurium had significant longer onset (233.33±62.31 vs. 86.66±28.62 seconds, p <0.001) and significant longer clinical duration (40±3.56 vs. 27.46±2.14 minutes, p <0.001) than rocuronium. Recovery index was significantly longer in the cisatracurium group (12.23±1.54 vs. 8.30±1.80 minutes, p <0.001). Clinically acceptable intubating conditions were achieved in 180 seconds (C group) compared to 60 seconds in the R group. No untoward or adverse response and complications were distinguished in either group. Conclusion: Cisatracurium 0.1 mg/kg exhibited a slower onset of action than rocuronium 0.6 mg/kg and provided excellent intubating conditions in the majority of patients after 180 seconds. The clinical duration and recovery index were significantly longer in cisatracurium compared to rocuronium. Both are potent and safe agents with excellent cardiovascular stability.

Rocuronium versus cisatracurium as adjuvants to local anesthetic in peribulbar-induced akinesia

Background and objectives Peribulbar anesthesia is widely used in cataract surgery, but the beginning of akinesia is much slower and slower compared with retrobulbar technique. The effect of using adjuvant to the peribulbar block for the development of improved conditions in the absence of any adverse effects and in fastening the onset of akinesia has been implicated. We investigate the effect of the use of rocuronium, cisatracurium, and hyaluronidase as adjuvants for the local anesthetic on peribulbar-induced akinesia in relation to the grade of akinesia. Patients and methods A total of 135 women were assigned for cataract surgery to three groups (45 patients in each group), who received local eye anesthesia of a mixture (8 ml) containing equal amounts of Marcaine 0.5% and lidocaine 2%, containing hyaluronidase 15 IU/ml plus 0.5 ml saline 0.9% (group C); a mixture (8 ml) containing equal parts of 0.5% Marcaine and 2% lidocaine plus 0.5 ml cisatracurium (1 mg) (group A); and a mixture (8 ml) containing equal parts of 0.5% Marcaine, 2% lidocaine plus 0.5 ml rocuronium (5 mg) (group R). Lid akinesia, globe akinesia, hemodynamics, and adverse effects were evaluated among groups. Results After 1 min of injection, the number of patients reaching total akinesia was 15 (33%) with rocuronium, nine (20%) with cisatracurium, and zero (0%) in the control group. After 3 min of injection, the total number of individuals achieving total immobility was 21 (46%) with rocuronium, 15 (33%) with cisatracurium, and six (13%) in the control group. After 5 min of injection, the number of patients reaching total akinesia was 33 (73%) with rocuronium, 27 (60%) with cisatracurium, and 21 (46%) with the control group. At the 10th minute after injection, the number of individuals reaching total akinesia was 39 (86%) with rocuronium, 33 (73%) with cisatracurium, and 30 (66%) with control. In groups of rocuronium and cisatracurium, the total akinesia is relatively more frequent than in the control group. The number of patients with complete akinesia was higher in the rocuronium group after 10 min than in the cisatracurium and control groups, but there was no statistically significant difference among the three groups regarding lid akinesia. We did not notice any adverse effects related to the peribulbar block or the drugs used during the study. Conclusion This study demonstrated that addition of low-dose cisatracurium and rocuronium to the anesthetic drug is recommended to improve the quality of akinesia especially when hyaluronidase is not added.

Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium.

ObjectiveThis study was performed to observe the occurrence of corrected QT (QTc) interval prolongation during anesthetic induction for laryngeal mask airway insertion and the effects of cisatracurium administration on the QTc interval.MethodsEighty-eight patients were assigned to two groups: the cisatracurium administration group (n = 45) and non-cisatracurium administration group (n = 43). The QTc interval was continuously recorded by a 12-lead Holter electrocardiogram beginning in the hospital ward and continuing until after anesthetic induction.ResultsIn the cisatracurium administration group, the QTc interval significantly increased from 417.9 ± 27.9 to 451.6 ± 32.5 ms after arrival in the operating room and significantly decreased to 432.4 ± 32.5 ms after a 15-minute rest; it significantly increased to 459.7 ± 23.8 ms again after propofol and fentanyl injection. However, the QTc interval decreased after cisatracurium injection. In the non-cisatracurium administration group, the QTc interval initially showed changes similar to those in the cisatracurium group until fentanyl and propofol were injected.ConclusionsThe QTc interval was significantly prolonged on arrival in the operating room and after propofol and fentanyl injection. The QTc interval did not significantly change by laryngeal mask airway insertion regardless of the administration of cisatracurium.

The effect of adding cisatracurium versus hyaluronidase to levobupivacaine and lidocaine mixture in single injection peribulbar block for cataract surgery

BackgroundSeveral adjuvants can be utilized to improve the quality of peribulbar block (PBB). We compared the effects of adding cisatracurium or hyaluronidase to levobupivacaine and lidocaine mixture for PBB on the onset of globe and lid akinesia in cataract surgery.Methods105 adult patients scheduled for cataract surgery under PBB were randomly allocated into three groups. Control group received 4 ml 0.5% levobupivacaine plus 3 ml 2% lidocaine diluted in saline to a total volume of 8 ml. Hyaluronidase 15 IU/ml and cisatracurium 1 mg were added to local anesthetics (LAs) mixture in hyaluronidase and cisatracurium groups respectively. Onset and duration of lid and globe akinesia, time for adequate conditions to start surgery and adverse events were recorded. Distribution of LAs solution was evaluated by B-scan ultrasound at 3 min and 10 min after injection of LAs.ResultsOnset of lid and globe akinesia, as well as time to adequate conditions to start surgery, were faster in cisatracurium and hyaluronidase groups compared to the control group (P < 0.05). Cisatracurium group had the fastest onset. At 3 min after injection of LAs, the ultrasound examination revealed that hyaluronidase group had the highest percentage of patients showing intraconal diffusion of LAs solution with the appearance of a characteristic T sign (P < 0.05).ConclusionsThe addition of cisatracurium 1 mg or hyaluronidase 15 IU/ml to levobupivacaine and lidocaine mixture for PBB hastened the onset of lid and globe akinesia without increase the incidence of adverse effects. This effect is more obvious with cisatracurium compared to hyaluronidase.

Effects of Combined Rocuronium and Cisatracurium in Laparoscopic Cholecystectomy.

BackgroundLaparoscopic upper abdominal surgery can cause spontaneous respiration due to diaphragmatic stimulation and intra-abdominal CO2 inflation. Therefore, sufficient muscle relaxation is necessary for a safe surgical environment.MethodsWe investigated if the combination of rocuronium and cisatracurium can counteract the delayed onset of cisatracurium’s action and delayed recovery of muscle relaxation and whether the dosage of rocuronium, which is metabolized hepatically, can be reduced. A total of 75 patients scheduled for laparoscopic cholecystectomy with an American Society of Anesthesiology physical status I-II, in the age range of 20–60 years, and with a 20–30 kg/m2 body mass index were included in the study.ResultsThe patients were divided into the following groups: combination group (Group RC, rocuronium 0.3 mg/kg and cisatracurium 0.05 mg/kg), rocuronium group (Group R, rocuronium 0.6 mg/kg), and cisatracurium group (Group C, cisatracurium 0.1 mg/kg), and the onset, 25% duration, recovery index, and addition/time ratio were measured. Patients in Group RC exhibited a significantly different addition/time ratio compared with patients in the other two groups (p = 0.003).ConclusionDuring laparoscopic cholecystectomy, the 95% effective dose of rocuronium in combination with cisatracurium is expected to provide a sufficient muscle relaxant effect.

The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit.

Background:A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion atracurium to continuous infusion cisatracurium in ICU patients.Materials and Methods:This retrospective cohort analysis reviewed 119 ICU patients who received either continuous infusion atracurium (56) or cisatracurium (63). The primary outcome was the incidence of hypotension (mean arterial pressure <60mmHg). Secondary outcomes included: incidence of blood pressure decrease of >20% from baseline, time to first hypotensive episode, treatment for hypotension during NMB use, hospital mortality, ICU and hospital length of stay (LOS), duration of mechanical ventilation (MV), and NMB duration.Results:Hypotension occurred in 64.3% of atracurium patients and 58.7% of cisatracurium patients (P = 0.58), with 60.7% experiencing >20% drop in blood pressure in atracurium group and 54.0% in cisatracurium (P = 0.58). Median time to first hypotensive episode was 9.4[Interquartile range 1.17-19.7] hours atracurium and 4.4[1.5-13.9] hours cisatracurium (P = 0.36). There were no differences between atracurium and cisatracurium groups respectively for median ICU LOS (10.5 days and 12.4 days, P = 0.34), hospital LOS (14.0 days and 17.7 days, P = 0.37), MV duration (9.3 days and 10.5 days, P = 0.43), infusion duration (34.5 hours and 25 hours P = 0.27), or hospital mortality (62.5% and 53.9%, P = 0.336). Hypotension treatment was similar between groups.Conclusions:The incidence of hypotension was similar between atracurium and cisatracurium. Critical drug shortages may provide an opportunity to study alternative drug therapy.

Efficacy of adding cisatracurium or rocuronium to the local anesthetic used for peribulbar anesthesia in patient undergoing cataract surgery

Objectives The peribulbar block (PBA) has been considered the sole of anesthetic of choice for cataract surgery. But it has a delayed onset of akinesia, which requires large volume of anesthetic solution and higher rate of supplementation when compared with retrobulbar anesthesia. We designed this study to evaluate the benefits of adding rocuronium and cisatracurium to PBA. Patients and methods In total, 60 patients were enrolled in this prospective randomized double-blind study and were subjected to cataract surgery. Patients were randomly divided into three groups equally: the first group (S) received PBA with 4-ml lignocaine 2%, 4-ml bupivacaine 0.5%, and hyaluronidase 30 IU/ml plus 0.5-ml normal saline. The second group (C) patients received 2.5-mg (0.5 ml) cisatracurium added to the standard local anesthetic mixture. The third group (R) patients received 5-mg (0.5 ml) rocuronium added to the standard local anesthetic mixture. The onset and duration of lid and globe akinesia were assessed. Results The onset of lid and globe akinesia was significantly shorter in the cisatracurium group compared with the other two groups (P Conclusion Adding muscle relaxant to the local anesthetic mixture (lidocaine, bupivacaine, and hyaluronidase) for PBA provides optimal globe akinesia, shortens the block onset time, and improves the postoperative analgesia.

Target-Controlled Infusion of Remifentanil Without Muscle Relaxants Allows Acceptable Surgical Conditions During Thoracotomy Performed Under Sevoflurane Anesthesia

To test the hypothesis that the use of a nonmuscle relaxant anesthetic technique (NMRT) during thoracotomy would be associated with comparable surgical conditions with the standard use of neuromuscular blocking drugs. A prospective, randomized, single-blind, controlled study. A single university hospital. Sixty-six patients scheduled for open thoracotomy under sevoflurane anesthesia with a target-controlled infusion (TCI) of remifentanil. After ethical approval, patients were randomly assigned to receive cisatracurium or saline (n = 33 for each group) during the entire study period. The four-point ordinal surgical rating scale, the intubating conditions, the use of anesthetics and vasopressors, the incidence of light anesthesia (defined as an episode with state entropy values that exceeded 50 and/or mean arterial blood pressure and heart rate values that exceeded the baseline by 20% and lasted for more than 3 consecutive minutes), and the times to clinical recovery and postanesthesia care unit (PACU) discharge, hospital stays, and postoperative residual curarization (PORC) were recorded. Compared with the use of cisatracurium, the use of NMRT resulted in comparable good-to-excellent surgical rating scales (90.9% v 94.0%, respectively; p = 0.642), good-to-excellent laryngoscopy and endobronchial intubating conditions (93.9% v 100%, respectively; p>0.09), use of anesthetic and vasopressor medications, and hospital stays, together with shorter clinical recovery, extubation times (7.6 [95% CI 6.82 to 8.39] v 19.0 [95% CI 15.76 to 22.23] minutes, respectively; p<0.001), and PACU stays (37.4 [95% CI 35.09 to 39.79] v 70.9 [95% CI 56.90 to 84.91] minutes, respectively; p<0.001). The use of cisatracurium resulted in a nonstatistical number of light anesthesia episodes upon positioning, skin incision, and rib separation (p>0.624,with Fisher's exact test). There were no failed intubations in the 2 groups. No patient received cisatracurium in the NMRT group. Two patients (6.1%) in the cisatracurium group experienced PORC that required tracheal intubation in the PACU. The use of TCI of remifentanil with NMRT offers acceptable laryngoscopy, intubating, and surgical conditions during sevoflurane anesthesia for open thoracotomy, especially when. the anesthesiologists have more than 10 years' experience.