DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20171677

A clinical comparative study of two intubating doses of cis-atracurium during general anaesthesia for gynaecological surgery

Prakash Jammar, Deba Gopal Pathak, Ismatara Begum, Ram Chandraji Chauhan

Abstract


Background: Cisatracurium is one of the cis-cis isomer of atracurium (51W89:1R-cis 1’R-cis atracurium) an intermediate duration non-depolarising neuromuscular blocking drug and is devoid of histamine release. However, 2× ED95 dose of cisatracurium does not provide satisfactory intubating condition. The recommended intubating dose of cisatracurium is 3 ×ED95. The objective of this study was to evaluate and compare duration of action, hemodynamic effects and any adverse effects for different doses of cisatracurium.

Methods: After Institutional Ethical Committee approval and informed patient consent, 80 patients of ASA I and II in the age group of 20-60 years were selected and included in the study. Patients were divided in two groups of 40 each, group A received intravenously 3×ED95 (0.15 mg/kg) loading dose of cisatracurium and group B received intravenously 4×ED95 (0.2 mg/kg) loading dose of cisatracurium.

Results: After induction, MAP and HR shows decrease in both groups but neither statistically nor clinically significant. Better hemodynamic stability and longer duration of action was found in group B compared to group A. No adverse effects noted in both groups.

Conclusions: 4×ED95 dose of cisatracurium provides longer duration of action and more stable hemodynamic status than 3×ED95. No associated signs of histamine release were detected clinically.


Keywords


Cisatracurium, ED 95 doses, Hemodynamic stability, Histamine release

Full Text:

PDF

References


Lien CA, Schmith VD, Belmont MR. Pharmacokinetics of cisatracurium in patients receiving nitrous oxide/opioid/barbiturate anesthesia: Anesthesiol. 1996;84:300-8.

Lien CA, Belmont MR, Abalos. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anaesthesia. Anesthesiol. 1995;82:1131-8.

Lepage, Jean-Yves, Malinovsky, Jean-Marc. Pharmacodynamic dose- response and safety study of cisatracurium (51W89) in adult surgical patients during N2 O-O2-opioid anesthesia. Anesthesia Analgesia. 1996;83(4):823-9.

Mellinghoff H, Diefenbach C. The clinical pharmacology of cisatracurium. Anaesth. 1997;46(6):481-5.

Konstadt Steven N, Reich David L, Stanley Thomas E. A two-center comparison of the cardiovascular effects of cisatracurium (Nimbex Trademmark) and vecuronium in patients with coronary artery disease. Anesth Analges. 1995;81(5):1010-4.

Welch RM, Brown A, Ravitch J, Dahl R. The in vitro degradation of cisatracurium, the R, cis-R'-isomer of atracurium, in human and rat plasma. Clin Pharmacol Ther. 1995;58(2):132-42.

7. Sparr HJ1, Beaufort TM, Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents? Drugs. 2001;61(7):919-42.

Doenicke A, Soukup J, Hoernecke R. The lack of histamine release with cisatracurium: a double-blind comparison with vecuronium. Anesth Analg. 1997;84:623-8.

Bryson HM, Faulds D. Cisatracurium besilate. A review of its pharmacology and clinical potential in anaesthetic practice: Drugs. 1997;53(5):848-66.

Adamus M, Gabrhelik T, Marek O. Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium. Eur J Anaesthesiol. 2008;25(7):589-95.

Wulf H, Kahl M, Ledowski T. Augmentation of neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia. Br J Anaesth. 1998;80;308-12.

Shahram A, Ali A, Masoud R. Comparison of the effects of different doses of cisatracurium on appropriate time for endotracheal intubation and hemodynamic changes during anesthesia. Zahedan J Res Med Sci. 2011;13(7):13-6.

Bergeron L, Bevan DR, Berrill A. Concenteration- effect relationship of cis-atracurium at three different dose levels in the anaesthetized patient. Anaesthesiol. 2001;95:314-23.

Bluestein LS, Stinson LW, Lennon RL. Evaluation of cisatracurium, a new neuromuscular blocking drug, for tracheal intubation. Can J Anaest. 1996;43(8):925-31.

ShangGuan W, Lian Q, Li J, Gao F. Clinical pharmacology of cisatracurium during nitrous oxide-propofol anesthesia in children. J Clin Anesth. 2008;20(6):411-4.

Taivainen T, Meakin GH, Meretoja OA. The safety and efficacy of cisatracurium 0.15 mg/kg 21 during nitrous oxide±opioid anaesthesia in infants and children. Anaesth. 2000;55:1047-51.

Sarooshian SS, Michael A, Stafford. Eastwood NB. Pharmacokinetics and pharmacodynamics of cisatracurium in young and elderly adult patients. Anaesthesiol. 1996;84:1083-91.

Ornstein E, Lien CA, Matteo RS. Pharmacokinetics and pharmacodynamics of cisatracurium in geriatric surgical patients. Anaesthesiol. 1996;84:520-5.

El-Kasaby AM, Atef HM, Helmy AM. Cisatracurium in different doses versus atracurium during general anaesthesia for abdominal surgery. Saudi J Anaesthe. Saudi J Anaesth. 2010;4(3):152-7.

Carroll MT, Mirakhur RK, Lowry D. A comparison of neuromuscular blocking effects and reversibility of cisatracurium versus atracurium. Anaesthe. 1998;53:744-8.