Cisatracurium besilate 20mg/10ml solution for injection ampoules

ObjectiveDesflurane is the most commonly suitable volatile anesthetic for elderly patients due to its low blood solubility, suggesting faster induction and awakening time. This study compared the safety and efficacy of desflurane versus sevoflurane in terms of postoperative cognitive function and early recovery quality in elderly orthopedic patients.MethodsEighty elderly patients undergoing orthopedic surgery were included in this prospective, randomized controlled trial. After preoxygenation with a 5 L/min fresh oxygen flow via a facial mask for 5 min, anesthesia was induced using 0.2 μg/kg sufentanil, 1-2 mg/kg etomidate, and 0.2 mg/kg cisatracurium. General anesthesia was maintained through continuous infusion of remifentanil (0.05-0.20 μg/kg/min) and a sevoflurane expiratory concentration of 1-2% or desflurane 2-5%, in combination with air containing 40% oxygen to maintain bispectral index (BIS) values 40-60. Data collected included hemodynamic parameters, time to eye-opening, extubation, following commands, orientation, post-anesthesia care unit (PACU) length of stay, opioid consumption, patient and surgeon satisfaction scores, number of patients willing to repeat surgery with the same anesthesia regimen, and adverse events. Additionally, white blood cell counts, percentages of neutrophils and lymphocytes, and troponin I levels were recorded at baseline and 24 h post-surgery.ResultsThe Mini-Mental State Examination (MMSE) scores were lower at 1 h post-surgery in the desflurane group (D group) than in the sevoflurane group (S group), although the difference was not clinically significant (p > 0.05). Over 70% of patients in both groups returned to baseline MMSE levels 24 h postoperatively. There were no significant differences in MMSE scores at baseline, 6, 24, or 48 h post-surgery between the groups (p > 0.05). Patients in the D group recovered significantly faster, indicated by shorter times to eye-opening, extubation, following commands, and reduced PACU length of stay (p p p p > 0.05).ConclusionDesflurane was not associated with reduced MMSE scores or postoperative respiratory complications. However, it demonstrated faster recovery times and higher patient satisfaction scores than sevoflurane.Clinical trial registrationChiCTR2400093852.

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BackgroundNeostigmine is widely used to reverse nondepolarizing neuromuscular blockade in children, but the optimal dose under total intravenous anesthesia is uncertain.AimsThe primary aim was to compare the time to full neuromuscular recovery (TOF ratio of 1.0) following administration of neostigmine at doses of 0, 10, 20, and 30 μg/kg in children at a TOF count of 3. Secondary objectives were full reversal within 10 min and adverse events.MethodsThis prospective, randomized, double-blind, parallel-group, superiority trial enrolled 120 children (2-10 years; ASA I-II) undergoing tonsillectomy. Participants received 0, 10, 20, or 30 μg/kg neostigmine at a TOF count of 3 measured by quantitative acceleromyography. The primary outcome was the time from TOF count of 3 to full reversal (TOF ratio = 1.0). Secondary outcomes were the proportion of patients achieving full reversal within 10 min and adverse events. Comparisons among active groups used the Kruskal-Wallis test.ResultsA total of 118 patients were analyzed. Median [IQR] time to full reversal was 20.2 [14.8-24.1], 14.0 [10.7-16.8], 11.0 [8.2-15.5], and 11.2 [7.9-14.6] min in the 0, 10, 20, and 30 μg/kg groups, respectively. Reversal was significantly slower in the control group compared with all neostigmine doses. However, there was no statistically significant difference among the active doses (Kruskal-Wallis, p = 0.33). At 10 min, full reversal had occurred in 10.7%, 23.3%, 43.3%, and 33.3% of patients in the respective groups. Adverse events were uncommon, occurring in 10 of 118 patients, and consisted exclusively of transient bradycardia and tachycardia, without differences among groups.ConclusionsAt TOF count of 3, neostigmine 10-30 μg/kg shortened reversal compared with no reversal, but doses above 10 μg/kg conferred no additional benefit. Quantitative monitoring remains essential, as fewer than half of patients achieved a TOF ratio of 1.0 within 10 min.Trial registryhttps://ensaiosclinicos.gov.br/rg/RBR-4xrx2g3.

Abstract licence: CC BY