Cisatracurium besilate 150mg/30ml solution for injection vials

Background: Transcranial motor-evoked potentials (TcMEPs) are essential for monitoring spinal cord integrity during spine surgery, but are highly sensitive to neuromuscular blocking agents. This study compared the effects of rocuronium reversed with sugammadex versus cisatracurium on TcMEP amplitude and recovery characteristics during thoracic and lumbar spine surgery. Methods: A double-blinded, randomized controlled trial was conducted in 60 patients undergoing elective spine surgery. Participants were randomized to receive either rocuronium 0.6 mg/kg with sugammadex reversal (Group R, n = 30) or cisatracurium 0.15 mg/kg (Group C, n = 30). Primary outcomes included MEP amplitude and latency at 5, 10, 20, 30, and 60 min post-obtaining the fourth twitch in the train-of-four (TOF) sequence with a peripheral nerve stimulator. Secondary outcomes measured TOF recovery times and intraoperative adverse events. Data were presented as mean ± standard deviation. The normally distributed continuous variables were compared using Student’s t-test, with P < 0.05 considered statistically significant. Results: Group R demonstrated significantly higher MEP amplitudes and shorter MEP latency at all time points from baseline till 30 min as compared to group C (P < 0.05). TOF recovery was significantly faster in group R (P < 0.001) as compared to group C. Group R had a higher incidence of nociception-induced movements (P = 0.076) and excessive field movements (P = 0.118), which was not statistically significant. The total propofol dosage in group R was significantly higher (P = 0.042) compared to group C. No postoperative neurological deficits occurred in either group. Conclusion: At similar TOF ratios, sugammadex-facilitated reversal of rocuronium results in superior quality of MEP parameters, such as higher MEP amplitude and shorter MEP latency, with no significant difference in adverse movements compared to single-dose cisatracurium.

Abstract licence: CC BY-NC-SA

BackgroundLaparoscopic partial hepatectomy, characterized by significant surgical trauma, profound stress responses, prolonged duration, and high anesthetic requirements, may lead to delayed recovery or emergence agitation. Whether remimazolam and propofol combined with flumazenil reversal can accelerate the recovery and enhance hemodynamic stability remains controversial.MethodsFifty patients aged 18-70 years with American Society of Anesthesiologists (ASA) class I-III and Child-Pugh classification A or B undergoing elective laparoscopic partial hepatectomy were enrolled. Participants were randomly assigned to either the remimazolam combined with propofol group (RP group) or the propofol group (P group). Both groups received intravenous sufentanil and cisatracurium for induction, followed by either remimazolam-propofol with flumazenil reversal or propofol alone. Emergence parameters, including time to obey verbal commands, BIS over 80, and tracheal tube removal were recorded. The Sedation-Agitation Scale (SAS) and Visual Analog Scale (VAS) scores at predefined intervals, hemodynamics, and adverse events were recorded.ResultsThe time to obey verbal commands (p), BIS over 80 (p =0.0011), and tracheal tube removal (p=0.0002) were all significantly shorter in the RP group than in the P group. The SAS score after 30 min (p=0.0488) in the PACU was significantly higher, but the VAS score after 15 min (p=0.0086) and 30 min (p=0.0084) in the PACU, were significantly lower in the RP group than in the P group. MAP at T1 (p=0.0470) was significantly lower in the P group than in the RP group. In addition, the RP group demonstrated reduced post-induction hypotension, required no postoperative rescue analgesia, and reported no emergence agitation.ConclusionCompared to propofol alone, remimazolam-propofol with flumazenil reversal provides faster and more complete recovery, superior hemodynamic stability perioperatively, and reduced analgesic requirements in laparoscopic partial hepatectomy patients.

Abstract licence: CC BY-NC