Rocuronium versus cisatracurium: onset of action, intubating conditions, efficacy, and safety

Neuromuscuiar blockers [NMB] are very important adjuvant to general anesthesia. Rocuronium bromide [ammosteroidal NMB] and cisatracunum besylate [benzyl isoquinolme NMB] are recently introduced non-depolarizing muscle relaxants In a prospective randomized study we had compared both drug at a dose 2x [ED95] as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects 40 female patients ASA l and ll. 20-50 year old underwent elective gynecological ambulatory surgery under general anesthesia [GA] were randomly assigned into 2 equal groups. ROC group, where 0.6mg/kg rocuronium was given and CIS group, where 0 1mg/kg cisatracurium was given. Neuromuscuiar monitoring was done by stimulating uinar nerve and recording the action potential of the first dorsal interosseous muscle using Date x Relaxogram. Standardized GA was given to all patients as follows, fentanyl 1.5mcg/kg. propofol 2mg/kg. 2x [ED95]/kg of the examined NMB. intubation was tried by the same anesthetist who was blind to the given NMB after 60 sec of injection, 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 60% N2O in 02 and isoflurane to a total MAC 1.5. controlled ventilation was adjusted to normocarpia. Mean arterial blood pressure [MAP], heart rate, and intubating conditions were recorded interpretation of relaxogram for the onset of action, clinical duration, recovery index was done Clinically acceptable intubating conditions were achieved after 60 sec more frequently after rocuronium [80%] than after ctsatracurium[O%]. Rocuronium had a significant shorter onset time than cisatracunum [70.6 +/- 18.2 versus 160.4 +/- 14.3sec], Rocuronium had a significant shorter duration of action than cisatracurium [30.3 +/- 5.2 versus 45.7 +/- 7/5min], and the spontaneous recovery index was significantly shorter with rocuronium than cisatracurium [9.2 +/- 1.8 versus 13.6 +/- 2.4min]. There were no evidences of any significant clinical cardiovascular changes in both groups. There were no clinical signs of histamine release in both groups, but there was burning pain at the site of rocuronium injection in more than 50% of patients 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

Ondansetron and tramadol for the treatment of post-extradural shivering

Sixty patients suffering from post-extradural shivering were randomly divided into three equal group. Group I, each patient received intravenous [IV] 0.5 mg /kg tramadol, and in group II, each patient was given 0.1 mg /kg IV ondansetron. while group III patients, received IV saline. The efficacy of both drugs on suppression of post-extradural shivering was compared. Onset at effect, the response rate and arrest time of shivering, heart rate, mean arterial pressure, blood gas changes, the level of plasma catecholamines and the incidence of adverse effects including recurrence of shivering were evaluated. Ondansetron could be considered an effective alternative to tramadol in aborting post-extradural shivering with high safety profile and no adverse effect