Abstract
Aims: In this study; we compared the effects of three different doses of cis-atracurium, a nondepolarizing muscle relaxant agent, on neuromuscular blockade duration, endotracheal intubation quality and hemodynamic parameters under isoflurane anaesthesia.
Methods: A total of 60 patients (ASA I-II) were included in the study. Patients were premedicated with 10 mg diazepam intramuscularly 45 minutes before the operation. After the patients were transferred to the operating room, they were monitored noninvasively for heart rate and arterial blood pressure. Train of Four (TOF)-GUARD acceleration monitor was used for neuromuscular evaluation. All patients were administered 1 mg/kg fentanyl and 2 mg/kg propofol at induction, and anaesthesia maintenance was provided with 1.5% isoflurane+50% N2O+50% O2. The patients were divided into three groups according to the dose of cisatracurium administered: 0.15 mg/kg was administered to Group 1, 0.20 mg/kg was administered to Group 2, and 0.40 mg/kg cis-atracurium was administered to Group 3. Endotracheal intubation was performed at 120 seconds, and the block time of 99-100% (effect onset time) was recorded.
Result: Although the endotracheal intubation quality was evaluated as excellent and/or good in all three groups, the intubation quality of Group 3 was statistically higher than the other two groups (p<0.05). In hemodynamic measurements, no significant difference was observed within and between groups in all three groups. While the onset of effect was significantly shorter in the third group compared to the other two groups, the clinical effect duration was more prolonged. No significant difference was observed between all three groups regarding the postoperative recovery period and quality.
Conclusion: The 0.4 mg/kg application dose of cis-atracurium is superior to other recommended dose groups due to its high intubation quality, short onset of action, not causing any severe hemodynamic changes or side effects, and good recovery quality and duration.
Keywords
Cis-atracurium neuromuscular block quality general anaesthesia nondepolarizing muscle relaxant
Ethical Statement
Since the study was old, local ethics were taken from the Ministry of Health Ankara Training and Research Hospital ethics committee at that time and published as a thesis. However, the records could not be accessed due to changes in hospital data processing. In this study, each patient provided informed consent prior to participation. All procedures followed were in accordance with the ethical standards (institutional and national) of the committee responsible for human experiments and the 1975 Declaration of Helsinki, revised in 2013.
Supporting Institution
The author declared that this study has received no financial support.
References
- Plaud B, Baillard C, Bourgain JL, et al. Guidelines on muscle relaxants and reversal in anaesthesia. Anaesthesia, Crit Care Pain Med. 2020;39(1):125-142.
- Bösenberg AT. Pediatric anesthesia in developing countries. Curr Opin Anaesthesiol. 2007;20(3):204-210.
- Cherian MN, Merry AF, Wilson IH. The World Health Organization and anaesthesia. Anaesthesia. 2007;62(1):65-66.
- Tonner PH. Balanced anaesthesia today. Best Pract Res Clin Anaesthesiol. 2005;19(3):475-484.
- Khan ZH, Hajipour A, Zebardast J, Alomairi SR. Muscle relaxants in anesthesia practice: a narrative review. Arch Anesthesiol Crit Care. 2018;4(4):547-552.
- Savarese JJ, Ginsburg S, Lee SM, Kitz RJ. The pharmacology of new short-acting nondepolarizing ester neuromuscular blocking agents: clinical implications. Anesthesia Analgesia. 1973;52(6):982-988.
- Belmont MR, Lien CA, Quessy S, et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. J Am Soc Anesthesiol. 1995;82(5):1139-1145.
- Kim JH, Lee YC, Lee SI, et al. Effective doses of cisatracurium in the adult and the elderly. Korean J Anesthesiol. 2016;69(5):453-459.
- Lien CA, Belmont MR, Abalos A, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. J Am Soc Anesthesiol. 1995;82:1131-1138.
- Heier T. Muscle relaxants. Tidsskrift Praktisk Med, Ny Raekke. 2010;130(4):398-401.
- Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesthesia Analgesia. 1970;49(6):924-934.
- Littlejohn IH, Abhay K, el Sayed A, Broomhead CJ, Duvaldestin P, Flynn PJ. Intubating conditions following 1R CIS, 1’R CIS atracurium (51W89). A comparison with atracurium. Anaesthesia. 1995;50(6):499-502.
- Bluestein LS, Stinson LW, Lennon RL, Quessy SN, Wilson RM. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesthesia. 1996;43(9):925-931.
- Lepage JY, Malinovsky JM, Malinge M, et al. Pharmacodynamic dose-response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2-opioid anesthesia. Anesthesia Analgesia. 1996;83(4):823-829.
- Deriaz H, Schmautz E, Vrillon M, Lienhart A. Evaluation of 51W89 for endotracheal intubation and repeated doses. In: Fukushima K, Ochiai R, eds. Muscle Relaxants: Physiologic And Pharmacologic Aspects. Springer: 1995:387.
- Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Can J Anaesthesia. 2003;50(8):779-794.
- Crystal R, Malone AA, Eastwood DM. Motor points for neuromuscular blockade of the adductor muscle group. Clin Orthop Relat Res. 2005;1;196-200.
- Mencke T, Schmartz D, Fuchs-Buder T. Neuromuscular monitoring. Der Anaesthesist. 2013;62(10):847-861.
- Bryson HM, Faulds D. Cisatracurium besilate: a review of its pharmacology and clinical potential in anaesthetic practice. Drugs. 1997;53(5):848-866.
- Reich DL, Mulier J, Viby-Mogensen J, et al. Comparison of the cardiovascular effects of cisatracurium and vecuronium in patients with coronary artery disease. Can J Anaesthesia. 1998;45(8):794-797.
- Konstadt SN, Reich DL, Stanley TE, et al. A two-center comparison of the cardiovascular effects of cisatracurium (Nimbex) and vecuronium in patients with coronary artery disease. Anesthesia Analgesia. 1995;81(5):1010-1014.
- Reich DL, Hollinger I, Harrington DJ, Seiden HS, Chakravorti S, Cook DR. Comparison of cisatracurium and vecuronium by infusion in neonates and small infants after congenital heart surgery. J Am Soc Anesthesiolog. 2004;101(5):1122-1127.
- Meretoja OA, Taivainen T, Wirtavuori K. Pharmacodynamic effects of 51W89, an isomer of atracurium, in children during halothane anaesthesia. Br J Anaesthesia. 1995;74(1):6-11.
- Meretoja O. Update on muscle relaxants. Paediatr Anaesthesia. 2004;14(5):384-386.
- Bergeron L, Bevan DR, Berrill A, Kahwaji R, Varin F. Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient. J Am Soc Anesthesiolog. 2001;95(2):314-323.
- Sorooshian SS, Stafford MA, Eastwood NB, Boyd AH, Hull CJ, Wright PM. Pharmacokinetics and pharmacodynamics of cisatracurium in young and elderly adult patients. J Am Soc Anesthesiolog. 1996;84(5):1083-1091.
- Keegan RD. Muscle relaxants and neuromuscular blockade. In: Grimm KA, Lamont LA, Tranquilli WJ, Greene SA, Robertson SA. Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones. John Wiley & Sons: 2015:260-276.
- Bowman WC. Neuromuscular block. Br J Pharmacol. 2006; 147(S1):S277-S286.
- Brandom BW, Westman HR. Effects of 0.86 mg/kg cisatracurium in an infant. J Am Soc Anesthesiolog. 1996;85(3):688-689.
Abstract
Amaç: Bu çalışmada, izofluran anestezisi altında nondepolarizan kas gevşetici bir ajan olan cis-atrakuryumun üç farklı dozunun, nöromusküler blokaj süresine, endotrakeal entübasyon kalitesine ve hemodinamik parametrelere olan etkilerini karşılaştırıldık.
Metot: Toplam 60 hasta (ASA I-II) çalışmaya dahil edildi. Hastalara operasyondan 45 dakika önce intramusküler 10 mg diazepam ile premedikasyon uygulandı. Hastalar operasyon odasına alındıktan sonra kalp atım hızı ve arteriyal kan basıncı takibi için noninvaziv olarak monitörize edildi. Nöromusküler değerlendirme için Train of Four (TOF)-GUARD akselerasyon monitörü kullanıldı. Tüm hastalara indüksiyonda 1 mg/kg fentanil ve 2 mg/kg propofol uygulandı ve anestezi idamesi %1.5 izofluran + %50 N20 + %50 02 ile sağlandı. Hastalar uygulanan cisatrakuryumun dozuna göre üç guba ayrıldı: Grup 1'e 0.15 mg/kg, Grup 2’ye 0.20 mg/kg ve Grup 3'e 0.40 mg/kg Cis-atrakuryum uygulandı. 120. saniyede endotrakeal entübasyon gerçekleştirildi ve %99-100'lük blok süresi (etki başlangıç süresi) kaydedildi.
Sonuç: Endotrakeal entübasyon kalitesi, her üç grupta da mükemmel ve/veya iyi olarak değerlendirilmesine rağmen Grup 3'ün entübasyon kalitesi, diğer iki gruba göre istatistiksel olarak daha yüksekti (p<0.05). Hemodinamik ölçümlerde, her üç grupta, grup içi ve gruplar arasında anlamlı bir fark gözlenmedi. Etki başlangıç süresi, 3. grupta, diğer iki gruba göre anlamlı olarak kısa iken, klinik etki süresi daha uzundu. Postoperatif derlenme süreleri ve kalitesi açısından her üç grup arasında anlamlı bir fark gözlenmedi.
Tartışma/Sonuç: Cis-atrakuryumun 0.4 mg/kg'lık uygulama dozu; entübasyon kalitesinin yüksek olması, etki başlama süresinin kısa olması, ciddi bir hemodinamik değişikliğe ve yan etkiye yol açmaması ve derlenme kalite ve sürelerinin iyi olması sebebiyle uygulanması önerilen diğer doz gruplarına göre daha iyi daha üstündür.
References
- Plaud B, Baillard C, Bourgain JL, et al. Guidelines on muscle relaxants and reversal in anaesthesia. Anaesthesia, Crit Care Pain Med. 2020;39(1):125-142.
- Bösenberg AT. Pediatric anesthesia in developing countries. Curr Opin Anaesthesiol. 2007;20(3):204-210.
- Cherian MN, Merry AF, Wilson IH. The World Health Organization and anaesthesia. Anaesthesia. 2007;62(1):65-66.
- Tonner PH. Balanced anaesthesia today. Best Pract Res Clin Anaesthesiol. 2005;19(3):475-484.
- Khan ZH, Hajipour A, Zebardast J, Alomairi SR. Muscle relaxants in anesthesia practice: a narrative review. Arch Anesthesiol Crit Care. 2018;4(4):547-552.
- Savarese JJ, Ginsburg S, Lee SM, Kitz RJ. The pharmacology of new short-acting nondepolarizing ester neuromuscular blocking agents: clinical implications. Anesthesia Analgesia. 1973;52(6):982-988.
- Belmont MR, Lien CA, Quessy S, et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. J Am Soc Anesthesiol. 1995;82(5):1139-1145.
- Kim JH, Lee YC, Lee SI, et al. Effective doses of cisatracurium in the adult and the elderly. Korean J Anesthesiol. 2016;69(5):453-459.
- Lien CA, Belmont MR, Abalos A, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. J Am Soc Anesthesiol. 1995;82:1131-1138.
- Heier T. Muscle relaxants. Tidsskrift Praktisk Med, Ny Raekke. 2010;130(4):398-401.
- Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesthesia Analgesia. 1970;49(6):924-934.
- Littlejohn IH, Abhay K, el Sayed A, Broomhead CJ, Duvaldestin P, Flynn PJ. Intubating conditions following 1R CIS, 1’R CIS atracurium (51W89). A comparison with atracurium. Anaesthesia. 1995;50(6):499-502.
- Bluestein LS, Stinson LW, Lennon RL, Quessy SN, Wilson RM. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesthesia. 1996;43(9):925-931.
- Lepage JY, Malinovsky JM, Malinge M, et al. Pharmacodynamic dose-response and safety study of cisatracurium (51W89) in adult surgical patients during N2O-O2-opioid anesthesia. Anesthesia Analgesia. 1996;83(4):823-829.
- Deriaz H, Schmautz E, Vrillon M, Lienhart A. Evaluation of 51W89 for endotracheal intubation and repeated doses. In: Fukushima K, Ochiai R, eds. Muscle Relaxants: Physiologic And Pharmacologic Aspects. Springer: 1995:387.
- Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Can J Anaesthesia. 2003;50(8):779-794.
- Crystal R, Malone AA, Eastwood DM. Motor points for neuromuscular blockade of the adductor muscle group. Clin Orthop Relat Res. 2005;1;196-200.
- Mencke T, Schmartz D, Fuchs-Buder T. Neuromuscular monitoring. Der Anaesthesist. 2013;62(10):847-861.
- Bryson HM, Faulds D. Cisatracurium besilate: a review of its pharmacology and clinical potential in anaesthetic practice. Drugs. 1997;53(5):848-866.
- Reich DL, Mulier J, Viby-Mogensen J, et al. Comparison of the cardiovascular effects of cisatracurium and vecuronium in patients with coronary artery disease. Can J Anaesthesia. 1998;45(8):794-797.
- Konstadt SN, Reich DL, Stanley TE, et al. A two-center comparison of the cardiovascular effects of cisatracurium (Nimbex) and vecuronium in patients with coronary artery disease. Anesthesia Analgesia. 1995;81(5):1010-1014.
- Reich DL, Hollinger I, Harrington DJ, Seiden HS, Chakravorti S, Cook DR. Comparison of cisatracurium and vecuronium by infusion in neonates and small infants after congenital heart surgery. J Am Soc Anesthesiolog. 2004;101(5):1122-1127.
- Meretoja OA, Taivainen T, Wirtavuori K. Pharmacodynamic effects of 51W89, an isomer of atracurium, in children during halothane anaesthesia. Br J Anaesthesia. 1995;74(1):6-11.
- Meretoja O. Update on muscle relaxants. Paediatr Anaesthesia. 2004;14(5):384-386.
- Bergeron L, Bevan DR, Berrill A, Kahwaji R, Varin F. Concentration-effect relationship of cisatracurium at three different dose levels in the anesthetized patient. J Am Soc Anesthesiolog. 2001;95(2):314-323.
- Sorooshian SS, Stafford MA, Eastwood NB, Boyd AH, Hull CJ, Wright PM. Pharmacokinetics and pharmacodynamics of cisatracurium in young and elderly adult patients. J Am Soc Anesthesiolog. 1996;84(5):1083-1091.
- Keegan RD. Muscle relaxants and neuromuscular blockade. In: Grimm KA, Lamont LA, Tranquilli WJ, Greene SA, Robertson SA. Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones. John Wiley & Sons: 2015:260-276.
- Bowman WC. Neuromuscular block. Br J Pharmacol. 2006; 147(S1):S277-S286.
- Brandom BW, Westman HR. Effects of 0.86 mg/kg cisatracurium in an infant. J Am Soc Anesthesiolog. 1996;85(3):688-689.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Publication Date | February 29, 2024 |
| Submission Date | January 14, 2024 |
| Acceptance Date | February 7, 2024 |
| Published in Issue | Year 2024 Volume: 5 Issue: 1 |
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