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Abstract
The introduction of muscle relaxants into clinical anesthesia occurred concomitantly with an increase in anesthetic complications. Nineteen percent of anesthetic deaths have been attributed to respiratory failure from residual muscle relaxants. Complete return of muscular activity to preoperative levels is difficult to determine clinically. Patients can sustain ventilation with normal carbon dioxide levels but may not be able to maintain airway patency. Neuromuscular blockers should be administered only to anesthetized individuals to provide relaxation of skeletal muscles. They should not be administered to stop patient movement because they have no analgesic or amnesic properties. Cisatracurium is an intermediate-acting neuromuscular blocking agent which is assumed to undergo Hofmann elimination and ester hydrolysis and, therefore, would not depend upon renal or liver function for elimination. The principal advantage of Cisatracurium is that there has been no evidence of histamine release at doses up to eight times the ED95. Rocuronium bromide is a new neuromuscular blocking agent and has recently been introduced into clinical practice. Its main advantage over other currently used drugs of this kind is its fast onset of action, which could render rocuronium the muscle relaxant of choice for rapid facilitation of tracheal intubation. It has a low tendency to produce histamine release. It is free of clinically significant cardiovascular side effects at effective neuromuscular blocking doses. This work aimed to compare the recovery from neuromuscular blockade after bolus then infusion of either cisatracurium or rocuronium. This study was carried out on thirty patients of both sexes from 40 to 60 years old scheduled for abdominal surgery more than three hours under general anesthesia. All patients were selected with American Society of Anesthesiologists (ASA) І or II health status as evident by history taking, clinical examination and laboratory investigations, admitted to general surgery Department in the Alexandria Main University Hospitals.
After having ethical committee approval and a written informed patient’s consent, patients were randomly allocated into 2 equal groups (15 patients each).
Group: I Patient received bolus dose (0.15 mg.kg-1), then infusion (1-2 μg.kg-1.min-1) of cisatracurium.
Group: II Patient received bolus dose (0.6 mg.kg-1), then infusion (9-12 μg.kg-1.min-1) of rocuronium.
All patients were pre-medicated with I.V. Fentanyl (1μg.kg-1) 5 minutes before induction of anesthesia. Induction of anesthesia was carried out with I.V. Propofol (2mg.kg- 1) Then cisatracurium (0.15mg.kg- 1) for group I, and rocuronium (0.6mg.kg-1) for group II was injected over 5 seconds to facilitate tracheal intubation which was done after recording 90%–95% T1 suppression. Anesthesia was maintained by isoflurane (1-2%) in 100% oxygen and fentanyl infusion (1 μg.Kg-1.hour-1) using syringe pump. Patients were all ASA I or II with exclusion of patients having hepatic, renal or neuromuscular disease. The parameters of this study used for measurement of degree of neuromuscular block which was monitored using the TOF-guard INMT nerve stimulator was evaluated through (Onset of neuromuscular block, duration of neuromuscular block, recovery index & TOF ratio 90%). Other parameters included measurement of intubation score, haemodynamic changes (heart rate and mean arterial blood pressure) and skin temperature, was also monitored and lastly assessment of oxygen saturation was done. In the present study, as regard the age, sex, weight, ASA score and the duration of the operations there are no significance difference between the two groups. As regards haemodynamics, the present study found out that there was no statistically significant difference between cisatracurium and rocuronium. The mean O2 saturation did not show any significant difference in comparison between both groups at any stage of measurement which was done continuously all through the operation. In this study as regard onset of action(T1 100% depression), there was a significance difference between both groups, so it was concluded that cisatracurium with a dose of 0.15 mg has slower onset of action than rocuronium in a dose of 0.6 mg.kg-1. As regard the duration of neuromuscular block (The time to 25% recovery of T1 response, in our study we found that there was a significance difference between both groups. So it was concluded that cisatracurium had a longer duration of neuromuscular blockade (T1 25%) than rocuronium. As regard the recovery index, we found that the recovery index which is the time of recovery from T1 25% to T1 75% in group I is shorter than group II, although the clinical duration for rocuronium is shorter than cisatracurium as seen before. As regard the complete recovery of neuromuscular block which occur at train of four (TOF) ratio 90% we found that there was a significance difference between both muscle relaxant. Rocuronium had a slower full recovery than cisatracurium. In our study the intubation occurred after recording T1 90% suppression, so intubation score was excellent, this mean that it was a smooth and easy intubation without cough or diaphragmatic movement in response to intubation and the vocal cords was opened in both muscle relaxants and no significance difference between them as regard the intubation score.