Effects of Atracurium and Cisatracurium on Pediatric Airway Pressure During Propofol Anesthesia
Background: This study aimed to determine the effects of two muscle relaxants, i.e. atracurium and cisatracurium, on airway pressure of pediatric patients during general anesthesia maintained by propofol.
Methods: This double-blind clinical trial included 68 two-five-year-old candidates for elective lower abdominal surgeries under propofol anesthesia. The patients were randomized to two groups to receive either atracurium or cisatracurium as muscle relaxant. The changes in airway pressures were evaluated during the procedure.
Results: Peak airway pressure from the 10th to the 45th minutes and plateau airway pressure from the fifth to the 45th minutes after the induction of anesthesia were significantly lower in the cisatracurium group (P = 0.005). Four patients (11.8%) from the atracurium group developed laryngospasm. However, the two groups had no significant difference in this regard (P = 0.11).
Conclusion: Comparison of the two muscle relaxants showed that cisatracurium had lower peak and plateau airway pressure in pediatric patients under general anesthesia maintained by propofol.
Cavuoto KM, Rodriguez LI, Tutiven J, Chang TC. General anesthesia in the pediatric population. Curr Opin Ophthalmol. 2014; 25(5):411-6.
Meretoja OA, Neuromuscular block and current treatment strategies for its reversal in children. Paediatr Anaesth. 2010; 20(7):591-604
Bowman WC. Neuromuscular block. Br J Pharmacol. 2006;147Suppl 1:S277-86.
Zielińska M, Zieliński S, Sniatkowska-Bartkowska. A Mechanical Ventilation in Children - Problems and Issues.AdvClinExp Med. 2014; 23(5):843-848.
Orestes MI, Lander L, Verghese S, Shah RK. Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy. Laryngoscope. 2012; 122(2):425-8.
Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001; 95(2):299-306.
Parnis SJ, Barker DS, van der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth. 2001; 11(1):29-40.
Yang CI, Fine GF, Jooste EH, Mutich R, Walczak SA, Motoyama EK. The effect of cisatracurium and rocuronium on lung function in anesthetized children. Anesth Analg. 2013; 117(6):1393-400.
Elwood T, Morris W, Martin LD, Nespeca MK, Wilson DA, Fleisher LA, et al. Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia. Can J Anaesth. 2003; 50(3):277-284
Rachel HJ, Elwood T, Peterson D, Rampersad S. Risk factors for adverse events in children with colds emerging from anesthesia: A logistic regression. Paediatr Anaesth. 2007; 17(2):154-61.
Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates and young children .Anesth Analg. 2007; 104(3):509-520.
Lauder GR. Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice. Paediatr Anaesth. 2015; 25(1):52-64.
Marik PE. Propofol: Therapeutic indications and side-effects. Curr Pharm Des. 2004; 10(29):3639-49
Morgan JM, Barker I, Peacock JE, Eissa A. A comparison of intubating conditions in children following induction of anaesthesia with propofol and suxamethonium or propofol and remifentanil. Anaesthesia. 2007; 62(2):135-9.