الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
This study was designed aiming to compare between Atracurium (2×ED95) and different doses of Cisatracurium (2×ED95, 4×ED95, 6×ED95) regarding; onset time, duration of action, condition of intubation, hemodynamic effects and sings of histamine release clinically. It was carried out as randomized controlled clinical trial.
Sixty four patients were randomly assigned to one of four groups, the first group (group 1) received 2×ED95 dose of atracurium, group 2 received 2×ED95 dose of cisatracurium, group 3 received 4×ED95 dose of cisatracurium, while group 4 received 6×ED95 dose of cisatracurium. All patients were assessed for hemodynamic state (heart rate, blood pressure), onset time, duration of action, and signs of histamine release clinically. Also condition of intubation and vocal cords assessment were compared among studied patients in the 4 groups of the study.
After data processing it was found that the 4 groups of the study were matched regarding age and sex.
There was statistically significant increase in heart rate after attempt of intubation when compared to base line reading after IV anesthesia and before injection of muscle relaxant with administration of 2×ED95 dose of atracurium in group 1 and the same dose of cisatracurium in group 2 (p-value < 0.05) but heart rate changes 5-20 minutes later wasn’t statistically significant when compared to baseline reading.. With administration of 4×ED95 and 6×ED95 doses of cisatracurium in group 3 and 4 respectively, change in heart rate wasn’t statistically significant either immediately after intubation or 5-20 minutes later (p-value > 0.05).
No statistically significant difference was noted between mean arterial blood pressure recordings 5-20 minutes after intubation and baseline reading after IV anesthesia in the 4 groups of the study (p-value > 0.05). While difference between mean arterial blood pressure after attempt of intubation and baseline reading after IV anesthesia was statistically significant with 2×ED95 dose of atracurium and cisatracurium, this difference was not statistically significant with 4×ED95 and 6×ED95 doses of cisatracurium.
Onset time was found to be significantly lower with 2×ED95 dose of atracurium than with the same dose of cisatracurium (p-value < 0.05). At the same time, higher doses of cisatracurium (4×ED95 and 4×ED95) showed onset time that was significantly lower than with atracurium and with lower dose of cisatracurium (2×ED95). Regarding the duration of action, higher doses of cisatracurium (4×ED95 and 6×ED95) shows statistically significant longer duration of action than lower doses of cisatracurium and the atracurium (2×ED95) (p-value < 0.05).
As regards the condition of intubation, it was estimated that only 6×ED95 dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent condition of intubation. 4×ED95 and 6×ED95 doses of cisatracurium were significantly better than 2×ED95 dose of cisatracurium. When it comes to the assessment of vocal cords, 2×ED95 dose of atracurium and 2×ED95 dose of cisatracurium were similar while 4×ED95 and 6×ED95 doses of cisatracurium were significantly better than atracurium and 2×ED95 dose of cisatracurium.
No signs of histamine release were noted with any doses of cisatracurium while it was noted with atracurium (2 cases; 1 case showed flush and the other case showed erythema).
from these results we can conclude that at the same dose (2×ED95 dose) atracurium is more effective neuromuscular blocking agent than cisatracurium, while higher doses of cisatracurium provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status and no associated signs of histamine release clinically.