Comparison of three different doses of cis-atracurium under isoflurane anesthesia

Year 2024, , 29 - 35, 29.02.2024

Ümit Murat Parpucu

https://doi.org/10.47582/jompac.1419484

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.

İzofluran anestezisi altında cis-atrakuryumun üç farklı dozunun karşılaştırılması

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.

Keywords

Cis-atrakuryum, nöromuskuler blok kalitesi, genel anestezi, nondepolarizan kas gevşetici

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