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It is worthwhile to note that the comparative clinical profile of rocuronium and cisatracurium are reported in less number. Armed with evidences of safety profile of these two drugs, we decided to find out if exceeding of the standard induction doses provides more favorable conditions for intubation. The proposed study was conducted on 90 patients who underwent elective surgeries under general anaesthesia the Department of Anaesthesiology, after obtaining ethical committee clearance. After taking written informed consent, 90 patients aged between 20 to 60 years belonging to ASA grade I and ASA grade II of either sex, undergoing elective surgery under general anaesthesia were included in the study. They were randomly divided into 3 groups of 30 patients each, who received one of the muscle relaxant for intubation. There are no dose-related effects on the incidence of changes from baseline (30% or greater) in mean arterial blood pressure or heart rate associated with rocuronium bromide administration over the dose range of 0.12 to 1.2 mg/kg (4 x ED95) within 5 minutes after rocuronium bromide administration and prior to intubation. [ABSTRACT FROM AUTHOR]

Background: Cisatracurium and rocuronium are non-depolarizing neuromuscular blockers with an intermediate duration of action and are used safely in short and intermediateduration surgical procedures in the pediatric population. Aims and Objectives: A prospective randomized study is to assess the efficacy of cisatracurium compared to rocuronium in terms of intubating conditions, clinical duration of action, hemodynamic parameters, and side effects in pediatric patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 50 patients aged 2-12 years with the American Society of Anesthesiologists grades I and II were randomly allocated into two groups: Group I received injection cisatracurium 0.15 mg/kg IV and Group II received injection rocuronium 0.6 mg/kg IV for intubation. Intubating conditions by Cooper et al., score, TOF count, hemodynamic parameters, signs of histamine release, and complications if any were noted. Results: According to the Cooper et al., score, intubating conditions were excellent in 100% of patients in Group II and 84% of patients in Group I, which was statistically significant. The time required for the first maintenance dose was shorter in Group II (14.04±2.95 min) compared to Group I (20.08±3.68 min). Hemodynamic parameters and demographic profiles were comparable between the two groups. No associated signs of histamine release or any other complications were noted in either group. Conclusion: We concluded that rocuronium 0.6 mg/kg provides better intubating conditions and a shorter duration of action compared to cisatracurium 0.15 mg/kg without any signs of histamine release in pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Shivering is often encountered in patients undergoing targeted temperature management (TTM) after cardiac arrest. The most efficient, safe way to prevent shivering during TTM is not clearly defined. Objective: The purpose of this study was to evaluate the impact of shivering management using a stepwise shivering protocol on time to target temperature (TT), medication utilization and nursing confidence. Methods: Single-center, retrospective chart review of all post-cardiac arrest patients who underwent TTM between 2016 and 2021. The primary outcome is a comparison of time to TT pre- and post-protocol implementation. Secondary objectives compared nursing confidence and medication utilization pre- and post-shivering protocol implementation. Results: Fifty-seven patients were included in the pre-protocol group and thirty-seven were in the post-protocol group. The median (IQR) time to TT was 195 (250) minutes and 165 (170), respectively (p = 0.190). The average doses of acetaminophen was 285 mg pre- vs 1994 mg post- (p <0.001, buspirone 47 mg pre- vs 127 mg post- (p < 0.001), magnesium 0.9 g pre-vs 2.8 g post- (p < 0.001), and fentanyl 1564 mcg pre- vs 2286 mcg post- (p=0.023). No difference was seen for midazolam and cisatracurium. Nurses reported feeling confident with his/her ability to manage shivering during TTM 38.5% of the time pre-protocol compared to 60% post-protocol (p = 0.306). Conclusion: Implementation of a stepwise approach to prevent and treat shivering improved time to TT in our institution, although this finding was not statistically significant. The stepwise protocol supported a reduced amount of high-risk medication use and increased nursing confidence in shivering management. [ABSTRACT FROM AUTHOR]

Background: Cisatracurium and rocuronium are non-depolarizing neuromuscular blockers with an intermediate duration of action and are used safely in short and intermediate-duration surgical procedures in the pediatric population. Aims and Objectives: A prospective randomized study is to assess the efficacy of cisatracurium compared to rocuronium in terms of intubating conditions, clinical duration of action, hemodynamic parameters, and side effects in pediatric patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 50 patients aged 2–12 years with the American Society of Anesthesiologists grades I and II were randomly allocated into two groups: Group I received injection cisatracurium 0.15 mg/kg IV and Group II received injection rocuronium 0.6 mg/kg IV for intubation. Intubating conditions by Cooper et al., score, TOF count, hemodynamic parameters, signs of histamine release, and complications if any were noted. Results: According to the Cooper et al., score, intubating conditions were excellent in 100% of patients in Group II and 84% of patients in Group I, which was statistically significant. The time required for the first maintenance dose was shorter in Group II (14.04±2.95 min) compared to Group I (20.08±3.68 min). Hemodynamic parameters and demographic profiles were comparable between the two groups. No associated signs of histamine release or any other complications were noted in either group. Conclusion: We concluded that rocuronium 0.6 mg/kg provides better intubating conditions and a shorter duration of action compared to cisatracurium 0.15 mg/kg without any signs of histamine release in pediatric patients.

Background and Aims: The present study was conducted to determine the optimal dose of cisatracurium for intubating conditions and onset and offset of neuromuscular blockade. Data in Indian population are scarce, and hence, the present study was planned to evaluate different doses of cisatracurium. Material and Methods: The prospective randomized double-blind study was conducted on 180 patients of either sex in the age group of 20-60 yrs., having physical status class I to III, scheduled for surgery under general anesthesia. After exclusion 154 patients were randomly divided into three groups comprising 52, 51, and 51, respectively, in Group A, Group B, and group C. They received 0.1 mgkg-1, 0.2 mgkg-1, and 0.3 mgkg-1 of cisatracurium, respectively, to facilitate endotracheal intubation. Time of onset, intubating conditions, hemodynamic parameters, signs of histamine release, and recovery time were noted. Results: Mean time to onset was maximum in group A (4.37 ± 0.48 minutes) and minimum in group C (2.33 ± 0.43 minutes). Intubating conditions were found excellent in 88% patients in group. Change in HR was found to be non-significant at all time periods, but decrease in MAP was found between 2 and 10 minutes in group C. Duration of action was longest in group C. Conclusion: We conclude that cisatracurium in dose of 0.2 mgkg-1 and 0.3 mgkg-1 provides good-to-excellent intubating conditions within less than 3 minutes. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to compare the effectiveness of atracurium 0.5 (2 ED95) mg/kg IV versus two different doses of cisatracurium, i.e., 0.1 (2 ED95) and 0.15 (3 ED95) mg/kg IV for intubation with regard to onset time for intubation, intubating conditions, duration of blockade, and hemodynamic parameters. Material & methods: A Prospective, randomized, single blinded study was conducted in the Department of Anaesthesiology in Chengalpattu medical college and hospital on patients undergoing surgery under General anaesthesia in between the duration of JUNE 2018-MAY 2019. 60 patients of ASA PS I and II were taken for the study. Institutional ethical committee approval was obtained. Permission from collaborating department was also obtained. The procedure was explained to the patient in their own mother tongue and written informed consent obtained. Results: There were more number of female patients in group 1 and 2 and more number of male patients in group 3. The age difference among the groups was not statistically significant (p>0.05). There was no significant difference between group 1 and 3(p>0.05) in jaw relaxation, vocal cord position and response to intubation. Heart rate, SBP and DBP were gradually returned to baseline at 5 minutes and may be due to stress response and was not statistically significant. Conclusion: Cisatracurium 0.15 mg/kg provides excellent intubating conditions with rapid onset of action, with longer duration of action and no significant hemodynamic changes when compared with cisatracurium 0.1 mg/kg and atracurium 0.5 mg/kg and hence cisatracurium 0.15 mg/kg can be used as an ideal non-depolarizing muscle relaxant for intubation. [ABSTRACT FROM AUTHOR]

Background and Aims: Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium. Material and Methods: One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects. Results: Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001). Conclusion: Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the therapeutic effect of cisatracurium, (a neuromuscular blocking agent) in the treatment of acute respiratory distress syndrome (ARDS). Methods: A total of 94 ARDS patients admitted to The Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture ICU from March 2020 to December 2021 were randomly assigned to study and control groups (47 patients each). Both groups received mechanical ventilation, but the study group also received continuous intravenous cisatracurium for 48 h. Health parameters, such as blood gas levels, respiratory mechanics, duration of stay in intensive care unit ICU), mortality rate, and the occurrence of complications, were monitored at 3, 6, and 12 months after treatment. Results: The study group showed significant improvements compared to control group. Study group also had reduced duration of mechanical ventilation, duration of ICU stay, ICU mortality rate, and incidence of complications (p < 0.05). There were no significant differences in pre-treatment health parameters, but post-treatment, study group had significantly higher levels of blood gas levels and improved lung function (p < 0.05). Study group also had lower scores of illness severity and reduced total mortality rate at 3, 6, and 12 months (p < 0.05). Conclusion: Administering cisatracurium reduces mechanical ventilation, duration of ICU stay and mortality rate, as well as improves lung function in ARDS patients. Future research involving larger sample size, and takes into consideration regional/environmental differences, is required to validate these findings for reliability. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study comparing the use of intermittent bolus injections and continuous infusion of cisatracurium, a muscle relaxant, in patients undergoing laparoscopic cholecystectomy. The study found that continuous infusion resulted in a lower total dose of cisatracurium used and a lower mean infusion rate compared to intermittent bolus injections. However, there was no significant difference in the duration of neuromuscular blockade or recovery index between the two methods. The study also noted that both methods were well-tolerated by patients, with no significant adverse events reported. These findings align with previous research on the use of cisatracurium and other muscle relaxants. [Extracted from the article]

Background: To determine the effect of neuromuscular blocking agents following pre- treatment with magnesium sulphate, investigation was done on the mechanism of pre-treatment with MgSO4 potentiating the onset and recovery characteristics of cisatracurium. Materials and Methods: After approval from Institutional Review Board, 48 patients belonging to ASA I and II were divided into two groups. Patients of group M received MgSO4 30 mg/kg in 0.9% normal saline (total volume 100 ml), and patients of group C received 0.9% normal saline (control group) alone intravenously (IV) for 15 min before induction with propofol, remifentanil and cisatracurium 0.15 mg/kg. Then anaesthetic effect was maintained using propofol and remifentanil by train-of-four, and the electromyographical responses were measured. Lag time, onset time, total recovery time, clinical duration, recovery index, recovery time, mean arterial blood pressure, heart rate, and ionised magnesium were measured. Results: The lag time and onset time were significantly shorter in group M than in group C (p<0.05). But recovery index, recovery time, clinical duration, and total recovery time showed no notable differences when compared (p>0.05). At the time point immediately after the administration of MgSO4, Mean arterial pressure was more significantly increased in group M than the group C. In both groups, heart rate showed no significant changes. At all the time points, ionised magnesium concentrations significantly increased (p<0.05). Conclusion: The use of MgSO4 has resulted in a shortening of the onset time of about 29% of cisatracurium (0.15 mg/kg) and without any change in the recovery of neuromuscular block. [ABSTRACT FROM AUTHOR]

Introduction: To compare the intubating conditions at 60 seconds between 4*ED95 dose of cisatracurium and 2*ED95 dose of cisatracurium in combination with priming and low dose ketamine Primary Objective: jaw relaxation for laryngoscopy, vocal cord position on laryngoscopy, and coughing or bucking response to intubation. Secondary Objective: To compare the hemodynamic changes up 10 minutes after intubation in the two groups. In this prospective study, a total of 68 patients were undergoing general anesthesia for surgery with placement of endotracheal tube placement. Patients will be divided into two groups comprising 34 patients each. The patients were allocated one of the two groups by computerized randomization. *Group A received bolus dose of cisatracurium which is 0.2 mg/kg (4*ED95). **Group B received cisatracurium in dose of 0.1 mg/kg (2*ED95) with priming (which is 10% of the bolus dose) and low dose ketamine of about 0.5 mg/kg. It was possible to achieve acceptable laryngoscopy and intubating condition in both the groups within 90 seconds. When grades of laryngoscopy and ease of intubation were compared, 2*ED95 dose along with priming plus low dose ketamine produced superior results than 4*ED95 group. When the mean arterial pressure and pulse rate were compared between the two groups, it was observed that mean arterial pressure and pulse rate were only slightly higher in the 2*ED95 along with priming and ketamine. [ABSTRACT FROM AUTHOR]

Background and Aims: Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium. Material and Methods: One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects. Results: Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001). Conclusion: Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.

Introduction: To compare the intubating conditions at 60 seconds between 4*ED95 dose of cisatracurium and 2*ED95 dose of cisatracurium in combination with priming and low dose ketamine Primary Objective: jaw relaxation for laryngoscopy, vocal cord position on laryngoscopy, and coughing or bucking response to intubation. Secondary Objective: To compare the hemodynamic changes up 10 minutes after intubation in the two groups. In this prospective study, a total of 68 patients were undergoing general anesthesia for surgery with placement of endotracheal tube placement. Patients will be divided into two groups comprising 34 patients each. The patients were allocated one of the two groups by computerized randomization. *Group A received bolus dose of cisatracurium which is 0.2 mg/kg (4*ED95). **Group B received cisatracurium in dose of 0.1 mg/kg (2*ED95) with priming (which is 10% of the bolus dose) and low dose ketamine of about 0.5 mg/kg. It was possible to achieve acceptable laryngoscopy and intubating condition in both the groups within 90 seconds. When grades of laryngoscopy and ease of intubation were compared, 2*ED95 dose along with priming plus low dose ketamine produced superior results than 4*ED95 group. When the mean arterial pressure and pulse rate were compared between the two groups, it was observed that mean arterial pressure and pulse rate were only slightly higher in the 2*ED95 along with priming and ketamine.

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.

Background: Stability study of a 10 mg/mL injectable cisatracurium solution stored refrigerated in amber glass ampoules for 18 months (M18). Methods: 4000 ampoules were aseptically compounded using European Pharmacopoeia (EP)-grade cisatracurium besylate, sterile water for injection, and benzenesulfonic acid. We developed and validated a stability-indicating HPLC-UV method for cisatracurium and laudanosine. At each stability study time point, we recorded the visual aspect, cisatracurium and laudanosine levels, pH, and osmolality. Sterility, bacterial endotoxin content, and non-visible particles in solution were checked after compounding (T0) and after M12 and M18 of storage. We used HPLC-MS/MS to identify the degradation products (DPs). Results: During the study, osmolality remained stable, pH decreased slightly, and the organoleptic properties did not change. The number of non-visible particles remained below the EP's threshold. Sterility was preserved, and bacterial endotoxin level remained below the calculated threshold. Cisatracurium concentration remained within the ±10% acceptance interval for 15 months and then decreased to 88.7% of C0 after M18. The laudanosine generated accounted for less than a fifth of the cisatracurium degradation, and three DPs were generated—identified as EP impurity A, impurities E/F, and impurities N/O. Conclusion: Compounded 10 mg/mL cisatracurium injectable solution is stable for at least 15 months. [ABSTRACT FROM AUTHOR]

Introduction: Atracurium is a benzyl-isoquinolinium, non-depolarizing neuromuscular blocking agent of intermediate duration of action. It has revolutionized anesthetic practice by providing muscle relaxation with faster onset, a more rapid measurable recovery. Cisatracurium is a recently introduced benzylisoquinolinium non-depolarizing neuromuscular drug which is a stereoisomer of Atracurium and constitutes about 15% of the commercially produced Atracurium and with a potency of three to four times greater than that of Atracurium. Materials and methods: This single center study was conducted in the Department of Anesthesiology at Maheshwara Medical College and Hospital over a period of 1 year. A total of 120 patients, 18-60 years of age. Patients were randomly divided into two groups; Group C received cisatracurium 0.1 mg/kg as muscle relaxant and Group A received atracurium 0.3 mg/kg IV. The mean onset time and duration of action for the two groups was done by Stockholm rules of the pharmacodynamic investigations of muscle relaxants activity. Intubating conditions, hemodynamic changes, and safety profile were noted. Result: In atracurium group, easy jaw opening was seen in 41 patients Comparatively in Cisatracurium group, jaw opening was easy in 45 patients and moderate in five patients. There was no statistically significant difference between two groups (P>0.05). In Group A, vocal cords were found in moving condition in about 35 patients while in 25 patients they were open, easing the intubation. In Group CA, vocal cords movement was seen in Twenty patients. It was found that vocal cord relaxation was better in Group CA, which was statistically significant (P<0.05). In Group A, 34 patients had slight diaphragmatic movement and 16 patients showed complete relaxation. However, in Group CA, 38 patients showed complete relaxation and only seven patients had mild cough reflex. Conclusion: It can be concluded that intubating conditions are better with 3ED95 dose of cisatracurium as compared to 2ED95 dose of atracurium. None of the participant showed signs of histamine release. Hence, cisatracurium can be considered as more efficacious as compared to atracurium. [ABSTRACT FROM AUTHOR]

Background: Skeletal muscle relaxation is integral part of general anesthesia. Non-depolarizing neuromuscular blocking drugs like cisatracurium are devoid of any signs of histamine release and can improve the quality of intubating conditions. Aims and Objectives: We decided to assess the efficacy of Cisatracurium when compared to atracurium in terms of intubating conditions and hemodynamic parameters in patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 80 patients in the age group of 20–65 years were randomly allocated into Group A received Atracuruium 0.5 mg/kg and Group B received Cisatracurium 0.15 mg/kg for intubation after administration of induction agent. Intuabating conditions were assessed by Cooper et al., score and hemodynamic parameters such as heart rate and blood pressure were recorded at 1, 3, 5, 10, 15, and 30 min of intubation. Any signs of histamine release were noted. Results: Demographic profile was comparable between the two groups. As per Cooper et al., score intubating conditions were excellent with Cisatracurium group as compared to the atracurium group which was statistically significant. Hemodynamic parameters during intubation and after intubation were comparable between two groups. No associated signs of histamine release were noted in either of the groups. Conclusion: From our clinical comparative study, we have observed that Cisatracurium 0.15 mg/kg provides better intubating conditions and stable hemodynamic profile with no signs of histamine release as compared to atracurium 0.5 mg/kg dose.

Abstract Background There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Methods Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected. Results Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups. Conclusions General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Trial registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020.

Purpose: Previous studies analyzing neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) have evaluated the benefit of cisatracurium with conflicting results, and data evaluating other NMBAs remains limited. The objective of this study was to compare the efficacy and safety of cisatracurium to vecuronium in ARDS. Materials and methods: A single-center, retrospective, propensity matched review of patients who received cisatracurium or vecuronium continuous infusions between October 1, 2017 and June 30, 2020 for ARDS was conducted. The primary endpoint was duration of mechanical ventilation. Secondary endpoints included change in PaO2/FiO2 ratio at 48 h, intensive care unit (ICU) and hospital mortality, and ICU and hospital length of stay (LOS). Safety endpoints included newly developed myopathy, presence of bradycardia or hypotension, and newly developed barotrauma or volutrauma. Results: Twenty-nine patients were included in each group. There was no statistically significant difference in the primary endpoint of ventilator days between cisatracurium and vecuronium groups (mean 15.9 vs. 20.5 days respectively; p =.2). No statistically significant differences were found in secondary endpoints of ICU mortality (51.7% vs. 51.7%) or length of stay (18.7 vs. 23.9 days, p =.19), hospital mortality (51.7% vs. 55.2%, p =.79) or length of stay (22 vs. 30.6 days, p =.08), or mean change in PaO2/FiO2 (29.8 vs. 36.6; p =.74). Statistically significant differences were not observed in safety endpoints of myopathy (37.9% vs. 37.9%), barotrauma or volutrauma (13.8% vs. 3.5%; p =.16), bradycardia (31% vs. 13.8%; p =.12), or hypotension (96.6% vs. 82.8%; p =.08) Conclusions: No significant differences were seen in efficacy or safety endpoints between cisatracurium or vecuronium groups, suggesting that vecuronium may be a safe alternative agent for neuromuscular blockade in ARDS. Results of this analysis warrant confirmation in a larger, randomized study. [ABSTRACT FROM AUTHOR]

We investigated the influence of different neuromuscular blocking agents and reversal agents during anaesthesia on early removal of chest tube drainage after video-assisted thoracoscopic surgery (VATS). This retrospective single-centre study included patients who underwent VATS after tracheal intubation under general anaesthesia. Patients received either cisatracurium and neostigmine (n =547) or rocuronium and sugammadex (n =151). Quantitative neuromuscular monitoring was used and one chest tube (size 24 Fr) was inserted. To reduce potential bias, 140 patients from each group were matched by propensity score for sex, age, body mass index and indication for VATS. Primary outcome was duration of chest tube drainage after surgery. Use of rocuronium and sugammadex was associated with a shorter duration of chest tube drainage (2 [1–2] vs 2 [1–3] days; P =0.049) and a 63% reduction in delayed chest tube removal (odds ratio 0.37; 95% confidence interval [CI]: 0.20–0.67; P =0.005). This group also had a lower incidence of postoperative atelectasis (P =0.047) and consolidation (P =0.008). Each 1 h increase in the duration of anaesthesia was associated with a 1.57-fold increase in the delayed removal of the chest tube (95% CI: 1.25–1.96; P =0.005). During general anaesthesia for VATS, compared with cisatracurium and neostigmine, use of rocuronium and sugammadex was associated with a significant decrease in the incidence of postoperative delayed removal of the chest tube, atelectasis, and pulmonary consolidation. [ABSTRACT FROM AUTHOR]

Background: Skeletal muscle relaxation is integral part of general anesthesia. Nondepolarizing neuromuscular blocking drugs like cisatracurium are devoid of any signs of histamine release and can improve the quality of intubating conditions. Aims and Objectives: We decided to assess the efficacy of Cisatracurium when compared to atracurium in terms of intubating conditions and hemodynamic parameters in patients undergoing surgeries under general anesthesia. Materials and Methods: In this study, 80 patients in the age group of 20-65 years were randomly allocated into Group A received Atracuruium 0.5 mg/kg and Group B received Cisatracurium 0.15 mg/kg for intubation after administration of induction agent. Intubating conditions were assessed by Cooper et al., score and hemodynamic parameters such as heart rate and blood pressure were recorded at 1, 3, 5, 10, 15, and 30 min of intubation. Any signs of histamine release were noted. Results: Demographic profile was comparable between the two groups. As per Cooper et al., score intubating conditions were excellent with Cisatracurium group as compared to the atracurium group which was statistically significant. Hemodynamic parameters during intubation and after intubation were comparable between two groups. No associated signs of histamine release were noted in either of the groups. Conclusion: From our clinical comparative study, we have observed that Cisatracurium 0.15 mg/kg provides better intubating conditions and stable hemodynamic profile with no signs of histamine release as compared to atracurium 0.5 mg/kg dose. [ABSTRACT FROM AUTHOR]

Background and aims Cisatracurium has many advantages over other nondepolarizing muscle relaxants; however, for rapid intubation, rocuronium is the preferred drug in lieu of succinylcholine. The aim of this study was to compare the onset time and intubating conditions at 90 s using 0.3 mg/kg cisatracurium (6x ED95) versus 1.2 mg/kg rocuronium (4x ED95). Material and methods The study was conducted at a tertiary care hospital as a randomized double-blind prospective study after obtaining the ethical committee clearance. A total of 60 patients were randomly assigned to receive 1.2 mg/kg rocuronium (4x ED95) or 0.3 mg/kg cisatracurium (6x ED95) after premedication with fentanyl-midazolam and induction with propofol-sevoflurane. Laryngoscopy and intubation were done at 90 s. Primary outcomes assessed were laryngoscopy and intubation conditions and onset times. The Student t test was used to compare prospective, repeated measures. χ² test was used to test the significance of difference for qualitative variables. Results The onset of action of the muscle relaxant was predicted by measuring train-of-four ratio and was found to be significantly longer in the cisatracurium group (149.50 ±25.064 s) than in the rocuronium group (101±s) (P<0.05). Although the intubating conditions were better in the rocuronium group, cisatracurium also provided good to excellent intubation conditions at 90 s. Conclusion Cisatracurium can be used to intubate the trachea at 90 s at a dose of 0.3 mg/kg in patients premedicated with fentanyl-midazolam and induced with propofol-sevoflurane, while maintaining hemodynamic stability, without increasing the incidence of adverse effects. [ABSTRACT FROM AUTHOR]

Abstract Background The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation. Methods A single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications. Results No significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001). Conclusions Compared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.

Background: There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage.Methods: Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected.Results: Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups.Conclusions: General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage.Trial Registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020. [ABSTRACT FROM AUTHOR]