EFFICACY OF ATRACURIUM VERSUS CISATRACURIUM IN PATIENTS UNDERGOING RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURE UNDER GENERAL ANAESTHESIA – A COMPARATIVE STUDY

Authors

  • ALISHA SAHU Department of Anaesthesiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
  • SAMBEET SWAIN Department of Anaesthesiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
  • SOUMYA SAMAL Department of Anaesthesiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
  • SIBANARAYAN MOHANTY Department of Anaesthesiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.

DOI:

https://doi.org/10.22159/ajpcr.2020.v13i7.37824

Keywords:

Efficacy, Atracurium, Cisatracurium, Endoscopic retrograde cholangiopancreatography

Abstract

Objectives: The objectives of the study were to compare the efficacy of injection atracurium 0.5 mg/kg intravenous (IV) versus injection cisatracurium 0.2 mg/kg IV for intubation in patients undergoing endoscopic retrograde cholangiopancreatography procedure (ERCP).

Methods: Hundred adult patients of both sexes in the age group of 18–60 years belonging to the American Society of Anesthesiologists I/II category posted for ERCP procedures under general anesthesia were randomly allocated into two groups of 50 each. Group A received injection atracurium besylate 0.5 mg/kg intravenously and Group B received injection cisatracurium besylate 0.2 mg/kg intravenously. Parameters observed were time to the maximum blockade, intubating condition, time required for intubation, duration of action, hemodynamic parameters during intubation, and after 1, 2, 3, 5, and 15 min and any adverse effects.

Results: Demographic profile was comparable between the groups. Intubating condition as per Cooper et al. score was excellent in 36 patients in cisatracurium group as compared to 19 patients in atracurium group. The overall intubating condition was found to be better in Group B (p=0.00001). Time to the maximum blockade was significantly high with atracurium as compared to cisatracurium. The mean of intubation time was less with cisatracurium (135±11.1) than that of atracurium (144±9.48) in seconds, which was statistically significant. Duration of neuromuscular blockade was found to be prolonged in Group B as compared to Group A (p=0.000). Hemodynamic parameters during intubation and after 1, 2, 3, 5, and 15 min were comparable between the groups. No adverse effect was seen in both groups.

Conclusion: Cisatracurium 0.2 mg/kg provides excellent intubating conditions with rapid onset of action, longer duration of action, and no significant hemodynamic changes as compared with atracurium 0.5 mg/kg for ERCP procedures without any adverse effects.

Downloads

Download data is not yet available.

Author Biography

SOUMYA SAMAL, Department of Anaesthesiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.

Anaesthesia

References

Thosani N. Deep sedation or general anesthesia for ERCP? Dig Dis Sci 2013;58:3061-3.

Smith ZL, Mullady DK, Lang GD, Das KK, Hovis RM, Patel RS, et al. A RCT evaluating general anesthesia endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation related adverse events during ERCP in high risk patients. Gastrointest Endosc 2019;89:855-62.

Shukla A, Mishra S. Ease of intubation: A randomized, double-blind study to compare two doses of rocuronium bromide for endotracheal intubation. Anesth Essay Res 2016;10:512-5.

El-Kasaby AM, Atef HM, Helmy AM, Abo El-Nasr M. Cisatracurium in different doses versus atracurium during general anaesthesia for abdominal surgery. Saudi J Anaesth 2010;4:152-7.

Lien CA, Schmith VD, Belmont MR, Abalos A, Kisor DF, Savarese JJ. Pharmacokinetics of cisatracuriumin patients receiving nitrous oxide/ opioid/barbiturate anesthesia. Anesthesiology 1996;84:300-8.

Kisor DF, Schmith VD, Wargin WA, Lien CA, Ornstein E, Cook DR. Importance of the organ-independent elimination of cisatracurium. Anesth Analg 1996;83:1065-71.

Lien CA, Belmont MR, Abalos A, Eppich L, Quessy S, Abou- Donia MM, et al. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/ barbiturate anesthesia. Anesthesiology 1995;82:1131-8.

Wastila WB, Maehr RB, Turner GL, Hill DA, Savarese JJ. Comparative pharmacology of cisatracurium (51W89), atracurium, and five isomers in cats. Anesthesiology 1996;85:169-77.

Savarese JJ, Wastila WB. The future of the benzylisoquinolinium relaxants. Acta Anaesthesiol Scand Suppl 1995;106:91-3.

Lennon L, Olson RA, Gronert GA. Atracurium or vecuronium for rapid sequence endotracheal intubation. Anesthesiology 1986;64:510-3.

Duggappa AK, Mathew S, Kordcal AR, Chakravarthi A, Muhamed S. Prospective comparative randomized controlled study to determine the optimal priming dose of atracurium. Indian J Respir Care 2018;7:42-5.

Deepika K, Kenaan CA, Bikhazi GB, Martineau DB. Influence of the priming technique on pharmacodynamics and intubating conditions of cisatracurium. J Clin Anesth 1999;11:572-5.

Bluestein LS, Stinson LW, Lennon RL, Wilson RM. Evaluation of cisatracurium, a new neuromuscular blocking agent for tracheal intubation. Can J Anaesth 1996;43:925-31.

Teymourian H, Mohamad AS, Seyed AM, Jafari A. Comparison of modified and high dose of cisatracurium for rapid sequence intubation. Asian J Pharm Nurs Med Sci 2014;2:2321-639.

Published

07-07-2020

How to Cite

SAHU, A., S. SWAIN, S. SAMAL, and S. MOHANTY. “EFFICACY OF ATRACURIUM VERSUS CISATRACURIUM IN PATIENTS UNDERGOING RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURE UNDER GENERAL ANAESTHESIA – A COMPARATIVE STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 13, no. 7, July 2020, pp. 199-03, doi:10.22159/ajpcr.2020.v13i7.37824.

Issue

Section

Original Article(s)