Comparison of Onset of Action, Intubating Conditions, and Recovery Characteristics of Rocuronium and Cisatracurium In Patients Undergoing Abdominal Surgery under General Anesthesia: A Prospective Randomized Control Trial
,
Abstract
Background: Neuromuscular blocking drugs (NMBD) have paved the way for the conduct of every known surgical procedure. However, the hunt for optimum NMD with appropriate intubating circumstances is continuous. Rocuronium and cisatracurium are amongst the newer NMBDs. We aim to compare the onset of action, intubating conditions, duration of action, and recovery features in a dose twice the ED95 in patients having abdominal surgery.
Methods: A total 60 American Society of Anesthesiology (ASA) I and II adult patients were randomized equally into Group A and Group B. Group A received Inj. Rocuronium 0.6 mg/kg and Group B received Inj. Cisatracurium 0.10 mg/kg. We assessed the intubating conditions after ensuring jaw relaxation using both the clinical criteria and neuromuscular monitoring whereas onset time, duration of action and recovery time were assessed using neuromuscular monitoring only.
Results: In Group A, a significant rapid onset of action of muscle relaxant was seen compared to Group B (2.4±0.30 mins versus 4.0±0.09 mins, p= 0.00). 93% patients had excellent intubating conditions in Group A compared to 73% patients in Group B (p= 0.038). The duration of action in Group A was 36.73±1.05 mins and in Group B was 47.40 ±1.33mins (p=0.00). Similarly, early mean duration of recovery was found in Group A-45.30±1.29mins versus Group B -57.77±1.19 mins, p= 0.00).
Conclusion: Rocuronium provides rapid onset of action with excellent intubating conditions, and shorter duration of action with an early recovery time compared to cisatracurium.
[2] Divatia J, Bhowmick K. Complications of endotracheal intubation and other airway management procedures. Indian J Anaesth. 2005; 49:308–18.
[3] Wierda JM, Hommes FD, Nap HJ, Van den Broek L. Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium. Anaesthesia. 1995; 50:393-6.
[4] Hunter JM. Rocuronium: the newest aminosteroid neuromuscular blocking drug. Br J Anaesth. 1996; 76:481-3.
[5] Cooper RA, Mirakhur RK, Maddineni VR. Neuromuscular effects of rocuronium bromide (Org 9426) during fentanyl and halothane anaesthesia. Anaesthesia. 1993; 48:103-5
[6] Bryson HM, Faulds D. Cisatracurium besilate. A review of its pharmacology and clinical potential in anesthetic practice. Drugs. 1997; 53: 848-66.
[7] Adamus M, Belohlavek R, Koutna J, Vujcikova M, Janaskova E. Cisatracurium vs. Rocuronium: a prospective, comparative, randomized study in adult patients under total intravenous anaesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2006; 150:333-8.
[8] McGrath CD, Hunter JM. Monitoring of neuromuscular block. Continuing Education in Anaesthesia, Critical Care & Pain 2006 ;6:7-12.
[9] Omera M, Hammad YM, Helmy AM. Rocuronium versus Cisatracurium: onset of action, intubating conditions, efficacy, and safety. AJAIC 2005; 8:27-33.
[10] Suri Y, Lamba NS, Krishna R. Neuromuscular Blockade and Intubation Conditions of the Single Bolus Dose (2xED90) Of Rocuronium Bromide. Med J Armed Forces India 2000; 56:10-2.
[11] Mohanty AK, Sarangi CR, Routray SS, Pattnaik A. Cisatracurium in different doses versus Atracurium during general anaesthesia for thyroid surgery: A comparative study. J Med Sci Clin Res. 2018; 6 :97-103.
[12] Lee H, Jeong S, Choi C, Jeong H, Lee S, Jeong S. Anesthesiologist's satisfaction using between cisatracurium and rocuronium for the intubation in the anesthesia induced by remifentanil and propofol. Korean J Anesthesiol. 2013; 64:34-9.
[13] Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997; 86:765-71.
[14] Carroll MT, Mirakhur RK, Lowry DW, McCourt KC, Kerr C. Neuromuscular blocking effects and train‐of‐four fade with cisatracurium: comparison with other nondepolarising relaxants. Anaesthesia. 1998; 53:1169-73.
[15] Ruetsch YA, Borgeat A. Withdrawal movements associated with the injection of rocuronium. Anesth Analg. 2000; 90:227-8.
[16] Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium: is pain on injection the cause? Br J Anaesth 1997; 79:382–3.
[17] Turan A, Memis D, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by magnesium sulphate, lignocaine, sodium bicarbonate and alfentanil. Anaesth Intensive Care. 2003; 31:277-81.
| Files | ||
| Issue | Vol 9 No Supp. 1 (2023): Supplement 1 |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i5.13954 | |
| Keywords | ||
| Rocuronium Cisatracurium Endotracheal intubation Neuromuscular blocking drugs Train of four count | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
