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Background:Cisatracurium is the stereoisomer of atracurium but has considerably higher neuromuscular blocking potency, better hemodynamic profile and no association with dose-dependent histamine release, as compared with the parent compound(1)(2,3). On the other hand, 2 ED95dose s of cis-atracurium (100? g/kg) do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium.There are limited studies which provide us the clarity of a better neuromuscular blocker in terms of intubation and maintainence amongst the two with the most optimum dose. Material And Methods:The study designed as randomised controlled trial, recruited 150 patients into three groups: Group A-atracurium 0.5 mg/kg(2×ED95), Group B and C-cis-atracurium 0.2 mg/kg (4×ED95) and 0.4 mg/kg (8×ED95)respectively and compared them on the basis of onset, duration of action, recovery time, haemodynamic effect and signs of histamine release clinically. Result:Patients in Group C had significantly shorter onset time of block when c ompared with group A & B. Mean duration of block after loading dose was significantly shorter in Group A than group B & C. Group B had a shorter duration of block than C. Recovery time of block in group A was significantly shorter than group B & C. Conclusion:Cis-atracurium in dose of 0.2 mg/kg seems to be better alternative to atracurium 0.5 mg/kg and cis-atracurium 0.4 mg/kg in providing faster onset, intermediate duration of action with fast recovery and it can be used for intubation as well as maintenance.
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Ojective To compara the individual differences and clinical efficacy of cis-atracurium intermittent bolus injected according to fat-free mass and real body weight. Methods Forty patients (ASAI-II) who had no neuromuscular disease and underwent selective abdominal surgery under general anesthesia were randomly divided into group FFM (n=20) and group RBW(n=20) according to the different administration method. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg, cis-atracurium 129.6μg/kg (group FFM) or 100μg /kg (group RBW),and maintained with propofol and fentanyl given by target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition. When the TOF stimulus T1 recovery to 5%, both group additional cis-atracurium 64.8 μg/kg (group FFM) or 50μg /kg (group RBW). The onset time, nonresponsive time, clinical duration, recovery index, pharmacological duration, cis-atracurium consumption, interval and frequency were recorded. Results No significant differences were found in general, interval, frequency,onset time, clinical duration, nonresponsive time,recovery index, pharmacological duration between the two groups (P > 0.05); There were significant differences in the cisatracurium consumption between two groups (P < 0.05); Compare with the group RBW, the differences of pharmacological duration and nonresponsive time between different individuals in group FFM were smaller (P < 0.05). Conclusion It can reduce the individual differences of muscle relaxant effect to apply cis-atracurium and cis-atracurium consumption according to fat-free mass.
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Objective To investigate the difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders. Methods 30 ASA Ⅰ or Ⅱ patients aged from 18 to 45 years who scheduled for laparoscopic operation were divided into two groups, male group( M group, n = 15 ) and female group ( F group,n = 15). After induction of Anesthesia all cases were maintained with remifentanyl 3μg/L(TCI) and sevoflurane.After 40 minutes of stable end-tidal anaesthetic concentration, a total dose of cisatracurium 45 μg/kg was divided into 3 equal doses( 15μ g/kg each) ,which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak ( T1 was no longer depressed in the height of 3 successive stimuli).Neuromuscular block was monitored using accelograph(TOF GUARD,Denmark). The onset time and maximum depression of T1 of the initial dose and 2 incremental doses were recorded. The cumulative dose-response curves of the two groups were established. The effective dose to obtain 50% and 95% neuromuscular block( ED5o and ED95 ,respectively) were calculated from individual dose-response curves. After the lastincrement of 15 μg/kg, the time for T1 to return to 25% ,50% ,75% and TOF ratio(T4/T1 )to 70% were recorded. The recovery index( RI)was also calculated.Results The mean ED5o and ED95(95% confidence interval)of cisatracurium of women were 22.2( 15.8 ～27.2)and 38.4 ( 32.1 ～ 54.4) μg/kg during sevoflurane (1.3MAC) anaesthesia, while the data of men were 25.6 ( 19.7 ～30.8) μg/kg and 42.8 ( 36.3 ～ 58.2 ) μg/kg, the difference between groups had no statistical significance ( P ＞0. 05). There was no significant difference in the TOF ratio ( T4/T1 ) to 70% and recovery index between the two groups( P ＞0.05 ). The onset time of F group was shorter than M group. The time for T1 to return to 25% ,50% and TOFR 0.7 was significantly longer in the F group than in the M group (P ＜ 0.05). Conclusion The neuromuscular blocking effect of cis-atracurium under 1.3MAC sevoflurane anesthesia remained no difference between genders. But the onset time of women was much faster. Furthermore the effect on the time for T1 to return to 25% ,50% and TOFR 0.7 were greater than men.
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Objective To observe the pharmacodynamic characteristics of different doses of cis-atracurium used in laparoscopic surgery on children.Methods 80 cases of selective laparoscopic surgery on children were randomly divided into 2 groups, 2 ED95 (Ⅰ group) or 3 ED95 (Ⅱ group) of cis-atracurium were intravenously given respectively.Record two group's muscle block time-effect and intubation conditions to observe the onset time of block, TOF-free response period, duration of anesthesia, muscle relaxation index and time in vivo recovery.Results Tracheal intubation in group Ⅱ with muscle relaxant block and intubation conditions better than groupⅠ;onset time of muscle relaxation in group Ⅱshorter than that in groupⅠ;TOF non-response period, maintain time of block and the time of function in vivo of two groups were different significantly;muscle recovery index were not significantly different Conclusion 3ED95 inducing dose of cis-atracurium effect on children with fast and excellent intubation conditions, and no response to TOF period and maintain time of block and the time of function in vivo longer than 2ED95 dose cis-atracurium;two groups had no significant difference in recovery index.
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BACKGREOUND: Several studies have demonstrated that atracurium produced cardiovascular response by releasing histamine but cis-atracurium has no any singnificant cardiovascular effect. However, evaluation of hemodynamic response of atracurium or cis-atracurium by using TEE has not yet to be reported. Accordingly, we evaluated the effect of atracurium or cis-atracurium on the left ventricular function of surgical patients using TEE. METHODS: Twenty adult patients were studied. Patients were intubated with thiopental sodium (4mg/kg), fentanyl (100 microgram) and succinylcholine (1.5 mg/kg) and anesthesia was maintained with enflurane (0.8%) and nitrous oxide (50%) and oxygen (50%). The patients were randomly assigned to give the neuromuscular blocking equipotent (2 x ED95) doses of atracurium or cis-atracurium. The transesophageal echocardiographic probe was inserted properly to measure the end-diastolic diameter, end-systolic diameter, end-diastolic area and end-systolic area. The stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), fractional shortening (FS), and fractional area change (FAC) were calculated. Heart rate (HR) and mean arterial pressures (MAP) were recorded and all data were collected just before, and 1, 2, 3, 5 and 10 minutes after injection of atracurium (0.5 mg/kg) or cis-atracurium (0.1 mg/kg). RESULTS: The MAP, SVI, CI, EF, FS, and FAC did not show any statistically significant changes after the drug administration in either groups and did not show any statistically significant difference between the two groups when compared at same time points. HR at 5 and 10 minutes after injection of cis- atracurium is significantly decreased than the control. CONCLUSIONS: Two times of ED95 dose of atracurium or cis-atracurium had no significant effects on left ventricular function in healthy adult patients during the general anesthesia with N2O-enflurane.