Atracurium besilate 25mg/2.5ml solution for injection ampoules

BackgroundMuscle relaxants are used during surgery, but their impact on ECG may differ, potentially affecting cardiac safety. This study aimed to compare the effects of Atracurium versus Cisatracurium on QT interval changes in patients undergoing cataract surgery.MethodThis double-blind, parallel-group randomized clinical trial (RCT) was conducted in 2023 in Hamadan, Iran. A total of 80 patients undergoing cataract surgery under general anesthesia were randomly assigned to receive either Atracurium (n = 40) or Cisatracurium (n = 40). QT interval changes were measured at four time points to assess and compare the corrected QT interval (QTc) between the two groups. Data were analyzed using SPSS version 29, and a p-value ResultsCisatracurium demonstrated significant reductions in QTc from pre-anesthesia to post-anesthesia and through recovery, with values of -9.325 ms (P = 0.045), -9.925 ms (P = 0.038), and - 19.359 ms (P = 0.016), respectively. Atracurium also showed reductions but a notable increase in QTc after anesthesia to the end of surgery (32.322 ms, P = 0.0019). Throughout the procedure, Cisatracurium maintained shorter QTc intervals compared to Atracurium (e.g., T0: 420.07 ms vs. 434.75 ms, P = 0.03), but post-recovery, no significant differences were observed (Cisatracurium: 440.05 ms; Atracurium: 439.80 ms, P = 0.489).ConclusionsAtracurium causes more QT prolongation than Cisatracurium. While both affect QTc intervals, Cisatracurium has a more stable impact on cardiac repolarization, making it safer for patients at risk of QT prolongation. Cisatracurium's minimal impact on cardiovascular function, especially in patients with low ejection fraction, makes it the preferred choice for maintaining cardiac stability.Trial registrationIRCT20120215009014N441.

Abstract licence: CC BY

BackgroundSuxamethonium, a rapid-acting muscle relaxant, has been conventionally preferred during rapid sequence induction (RSI). The priming principle, which uses non-depolarising muscle relaxants, is an alternative in situations where it is contraindicated. Unfortunately, its efficacy has not been sufficiently documented in Nigerian patients.AimsThe study aimed to use atracurium and pacuronium to evaluate the efficacy of the priming principle.Materials and methodsIn this randomised controlled trial, ninety adults undergoing elective surgery under general anaesthesia were randomly allocated into three equal groups. Group A (Atracurium), Group P (Pancuronium) and Group C (control) received 0.05 mg/kg atracurium, 0.01 mg/kg pancuronium and 1 ml saline, respectively, as the priming agent. Three minutes after, anaesthesia was induced with 2 mg/kg propofol and then the intubating dose of pancuronium administered. The onset time of neuromuscular block, intubating condition and occurrence of muscle weakness during the priming interval were noted. Data were analysed using the Statistical Package for the Social Sciences version 25, and a P ResultsThe mean onset time in Groups A, P and C was 215.7 ± 59.9 s, 237.1 ± 76.5 s and 265.8 ± 72.0 s, respectively, P = 0.024. Post hoc analysis showed that the onset time was only significant between Groups A and C (P = 0.02). The intubating condition was comparable in all groups (P = 0.25). The incidence of muscle weakness during the priming interval was 6.67% in the priming groups.ConclusionIn adults, priming with atracurium but not pancuronium shortens the onset time of pancuronium. However, during RSI, where a fast onset is crucial, the shortened onset time with priming is not clinically relevant.

Abstract licence: CC BY-NC-SA

BackgroundIt is uncertain whether neostigmine reversal improves postoperative pulmonary outcomes. This study aimed to evaluate the association between neostigmine and postoperative atelectasis, and other complications in elderly patients undergoing laparoscopic pancreaticoduodenectomy (LPD).MethodsThis single-center retrospective cohort study included elderly patients who underwent LPD between 2019 and 2022, using cis-atracurium as the sole neuromuscular blocking agent. Participants were divided into two groups based on exposure to neostigmine: the neostigmine reversal group (exposed) and the control group (not exposed). The primary endpoint was the incidence of atelectasis within the first 3 postoperative days. Secondary endpoints included the incidence of pneumonia, pleural effusion, acute respiratory distress syndrome (ARDS), time to extubation, length of stay in the post-anesthesia care unit (PACU) and hospital, reintubation, postoperative blood gas analysis, 30-day readmission, and 30-day mortality. Propensity score matching (PSM) was performed based on baseline and intraoperative characteristics to minimize potential bias.ResultsOf the 501 patients initially included, 302 were successfully matched after PSM at a 1:5 ratio, comprising 89 patients in the neostigmine reversal group and 213 in the control group. Compared to the control group, the incidence of postoperative atelectasis was lower in the neostigmine reversal group (OR 0.43 [95% CI 0.24-0.75], p = 0.003) in elderly patients undergoing elective LPD. For secondary outcomes, time to extubation (Median [IQR] 20.00 [10.00-32.50] min vs. 25.00 [15.00-41.00] min, p ConclusionsIn this single-center PSM study, neostigmine reversal was associated with lower incidence of atelectasis within the first 3 postoperative days, shorter time to extubation, shorter length of stay in the PACU, and increased OI at 2 h after extubation in elderly patients undergoing elective LPD. Postoperative atelectasis was associated with older age, greater intraoperative total fluid infusion, and the absence of neostigmine reversal. These results should be interpreted as hypothesis-generating, and warrant validation through randomized controlled trials.

Abstract licence: CC BY-NC-ND