Anisha Deulker1, Rohini Bhat Pai2, Shaila Kamat3, Eufemia Dias4, Rachel Botelho5, Gayatri Kamat6, Uma Sahakari7, Rukmi Pai Raiker8
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 <
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.
