Abstract
Purpose
The primary objective of this study was a blinded, randomized comparison of the recommended intubating dose of atracurium (0.5 mg·kg−1) with an approximately equipotent dose of cisatracurium (0.1 mg·kg−1) during N20/02/propofol/ fentanyl anaesthesia.
Methods
Eighty ASA physical status 1 or 2 patients, 18–70 yr of age, within 30% of ideal body weight, scheduled for elective low to moderate risk, surgical procedures were studied. Adductor pollicis evoked twitch responses were measured with a Grass FT 10 force displacement transducer (Grass Instruments, Quincy, MA) and continuously recorded on a Gould multichannel polygraph (Gould Instrument Systems, Cleveland, OH) after induction of anaesthesia.
Results
Increasing the initial dose of cisatracurium (from 0.1 to 0.15 and 0.2 mg·kg−1, decreased mean time of onset (from 4.6 to 3.4 and 2.8 min, respectively), and increased mean time of clinically effective duration (45 to 55 and 61 min, respectively). Recovery to a T4:T1 ratio of 0.7 occurred approximately seven minutes following administration of the reversal agent neostigmine for all treatment groups. Intubation conditions were good or excellent in over 90% of patients in all treatment groups (two minutes after approximately 2 x ED95 doses of cisatracurium or atracurium and 1.5 minutes after 3 × and 4 × ED95 doses of cisatracurium).
Conclusion
The intubation results reported in this study together with the combination of predictable recovery from neuromuscular block and apparent haemodynamic stability make cisatracurium a potentially useful muscle relaxant in clinical practice.
Résumé
Objectif
Comparer aléatoirement et en aveugle la dose d’atracurium recommandée pour l’intubation (0,5 mg·kg−1) avec une dose approximative équipotente de cisatracurium (0,1 mg·kg−1) pendant une anesthésie associant N2O/O2/propofol/ fentanyl.
Méthodes
L’étude portait sur 84 patients ASA 1 et 2, âgés de 18 à 70 ans, dont le poids ne déviait pas de plus de 30% du poids idéal, programmés pour une chirurgie non urgente comportant un risque faible ou modéré. Le twitch évoqué à l’adducteur du pouce était mesuré après l’induction de l’anesthésie à l’aide d’un transducteur Grass FT 10 (Grass Instrument, Quincy, MA) et enregistré en continu sur un polygraphe Gould (Gould Instrument System, Cleveland, OH).
Résultats
L’augmentation de la dose initiale de cisatracurium (de 0,1 à 0,15 et à 0,2 mg·kg−1) diminuait l’installation du bloc (respectivement de 4,6 à 2,8 min) et augmentait la durée moyenne d’efficacité clinique (respectivement de 45 à 55 et à 61 min). La récupération à 0,7 du rapport T4/T1 survenait environ sept minutes après l’administration de l’antagoniste néostigmine dans tous les groupes. Les conditions pour l’intubation étaient de bonnes à excellentes chez plus de 90% des patients de tous les groupes (deux minutes après des doses d’environ 2 × ED50 de cisatracurium ou d’atracurium et 1,5 min après 3 × et 4 × ED50 de cisatracurium).
Conclusion
Les résultats rapportés dans cette étude concernant l’intubation associés avec un récupération prévisible du bloc au cisatracurium et sa stabilité hémodynamique apparente montrent que le cisatracurium pourrait être un relaxant musculaire utile en clinique.
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Sponsored by a grant from Burroughs Wellcome Co., Research Triangle Park; NC.
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Bluestein, L.S., Stinson, L.W., Lennon, R.L. et al. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesth 43, 925–931 (1996). https://doi.org/10.1007/BF03011806
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DOI: https://doi.org/10.1007/BF03011806