Cisatracurium besilate 20mg/10ml solution for injection vials

BACKGROUND: Residual neuromuscular block after using neuromuscular blocking agents is a common and potentially harmful complication of general anesthesia. Neostigmine is a widely used antagonist, but its optimal dose for elderly patients is unclear. OBJECTIVES: To compare the optimal dosage and safety of neostigmine for reversing shallow residual block in elderly patients after cisatracurium-induced neuromuscular block. METHODS: A randomized controlled trial was conducted in 196 elderly patients undergoing non-cardiac surgery under general anesthesia with cisatracurium. Patients were assigned to receive either no neostigmine (control group) or neostigmine at 20 µg/kg, 40 µg/kg or 50 µg/kg when train-of-four (TOF) ratio reached 0.2 at the end of surgery. The primary outcome was the time to reach TOF ratio of 0.9 after administration. Secondary outcomes included TOF ratio at 10 min after administration, postoperative nausea and vomiting, postoperative cognitive impairment and post-anesthesia care unit (PACU) stay time. RESULTS: The time to reach TOF ratio of 0.9 in the 20 µg/kg, 40 µg/kg and 50 µg/kg groups was significantly shorter than the control group (H = 104.257, P < 0.01), and the time of 40 µg/kg group and 50 µg/kg group was significantly shorter than the 20 µg/kg group (P < 0.001). There was no significant difference between 40 µg/kg and 50 µg/kg groups (P = 0.249). The TOF ratio at 10 min after administration showed similar results. There were no significant differences among groups in postoperative nausea and vomiting, postoperative cognitive impairment or post-operation hospital stay. CONCLUSIONS: Timely use of neostigmine after general anesthesia in elderly patients can significantly shorten time of TOF value reaching 0.9, among which 40 µg/kg dosage may be a more optimized choice. TRIAL REGISTRATION: this study was registered on chictr.org.cn (ChiCTR2100054685, 24/12/2021).

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Background: Muscle relaxants are used for two general purposes. One is to ease endotracheal intubation, and the other is provide surgical relaxation. This study has been designed with the aim of assessing the impact of atracurium and cisatracurium on patients at the anesthesia induction and the neutrophil to lymphocyte ratio. Methods: This is a randomized clinical trial that was performed in 2022-2023 in Kashani hospital in Isfahan, Iran on patients that were candidates for elective surgery under general anesthesia by atracurium or cisatracurium. A total number of 80 patients entered and were randomized into two group’s one receiving group atracurium 0.5mg/kg, and other group received cisatracurium 0.15mg/kg over 60 seconds as NMB. Blood sample were taken base time, after 3, and 20 minutes following intubation. Qualitative data is reported as frequency with percentage. And quantitative data as average with standard deviation. Statistical analysis was done using SPSS version 25. Qualitative data were analyzed using chi-square tests and quantitative data using independent T test. Significance level was defined as p value &lt;0.05. Results: Overall, 80 patients were enrolled in this study. 40 of them belonged to the cisatracurium group and 40 to the atracurium group. Average age of the participants was 42.86 (±14.52) years old. Mean arterial pressure (MAP) in cisatracurium group dropped significantly following intubation (p&lt;0.005), while it rose significantly in the atracurium group (p&lt;0.05). However neutrophil to lymphocyte ratio (NLR) was significantly higher in the cisatracurium group following intubation (P&lt;0.05). Conclusion: While the use of atracurium in patients is still safe, is yet more correlated with pronounced hemodynamic instability compared to cisatracurium.

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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.

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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 &lt; 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 &lt; 0.05). TOF recovery was significantly faster in group R ( P &lt; 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.

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BACKGROUND: Esketamine has been increasingly used as an adjuvant for propofol-based induction. However, the effective esketamine dose for this indication remains unclear. The authors investigated the effect of different intravenous bolus low doses of esketamine pretreatment on the propofol requirements and the onset time of cisatracurium during anesthesia induction. METHODS: 140 patients undergoing elective surgery under general anesthesia were randomly allocated into four groups: pretreatment with saline (Group C), pretreatment with 0.1 mg/kg esketamine (Group K0.1), pretreatment with 0.3 mg/kg esketamine (Group K0.3), and pretreatment with 0.5 mg/kg esketamine (Group K0.5). The propofol dosage was recorded when the eyelash reflex disappeared and the Index of Consciousness (IoC) value reached 60 during the infusion. The onset time for cisatracurium was recorded. RESULTS: The total dose of propofol at the point of eyelash reflex loss was significantly lower in group K0.5 than in groups K0.3 (P = 0.019), K0.1 (P < 0.001) and C (P < 0.001). The dose of propofol at the point of the loss of eyelash reflex was lower in group K0.3 than in groups K0.1 (P = 0.006) and C (P < 0.001). The total dose of propofol at an IoC value of 60 was significantly higher in group K0.5 than in groups K0.1 (P < 0.001) and C (P < 0.001). The dose of propofol at an IoC value of 60 was higher in group K0.3 than in groups K0.1 (P = 0.009) and C (P < 0.001). The onset time of cisatracurium during induction was not significantly different among the groups. CONCLUSION: Esketamine decreases the dose of propofol in a dose-dependent manner at the point of the loss of eyelash reflex, while 0.5 mg/kg esketamine and 0.3 mg/kg esketamine pretreatment before induction significantly increase the dose of propofol at the targeted IoC value of 60. Esketamine does not affect the onset time of cisatracurium when it is combined with propofol during IoC-guided induction of anesthesia. CLINICAL TRIAL NUMBER: Clinical trial number and registry URL: ChiCTR2000041041, registration date: December 16, 2020 http://www.chictr.org.cn .

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Context and Aims: Intermediate-acting, nondepolarizing neuromuscular blocking drugs (NMBDs), such as cisatracurium and rocuronium, are commonly used in cardiac surgery. Pharmacokinetics of NMBD alters with hypothermia. This study aims to examine the dosing interval of maintenance doses of rocuronium and cisatracurium required during moderate hypothermic (28°C–32°C) cardiopulmonary bypass (CPB). Subjects and Methods: In this prospective randomized controlled trial, patients were allocated into two groups of 30 patients each. Standard induction was performed with Group A receiving 0.1 mg/kg cisatracurium. Group B received 0.6 mg/kg rocuronium to facilitate intubation. Group A and Group B received intermittent bolus doses of 0.02 mg/kg of cisatracurium and 0.12 mg/kg of rocuronium, respectively, whenever one twitch response appeared to maintain zero twitch TOF. Results: Intergroup analyses revealed the increase in duration of action (DOA) of rocuronium was statistically significant than cisatracurium during CPB ( P = 0.001) and post-CPB ( P = 0.001). Intragroup analyses revealed that the difference in DOA of rocuronium and cisatracurium was significantly prolonged during CPB ( P = 0.001 and P = 0.001, respectively) and post-CPB ( P = 0.001 and P = 0.04, respectively) compared to the pre-CPB period. Cisatracurium was administered significantly more number of times as compared to rocuronium on CPB, while the number of times of drug administration was comparable pre-and post-CPB. Conclusions: There is significant prolonged DOA of both cisatracurium and rocuronium on moderate hypothermic CPB as evidenced by neuromuscular monitoring guided dosing during CPB. Conservative dosing of NMBD during CPB might help in fast-tracking patients postoperatively.

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BACKGROUND: Postoperative pain usually occur in patients who have undergone functional endoscopic sinus surgery (FESS). Remimazolam and dexmedetomidine could enhance the quality of recovery (QoR) after surgery. The aim of this study was to compare the effects of remimazolam and dexmedetomidine with respect to the QoR-40 score of patients who have undergone FESS. METHODS: A total of 120 patients (18-65 years) scheduled for FESS were randomly allocated to Group R, Group D or Group C. Group R received 0.075 mg/kg remimazolam loading and 0.1 mg/kg/h infusion. Group D received dexmedetomidine (1.0 µg/kg loading, 0.5 µg/kg/h infusion). Group C received a placebo equal to dexmedetomidine. Anaesthesia was induced with propofol, sufentanil and cisatracurium. Anaesthesia maintenance was performed via target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome was the QoR-40 score on the day before surgery and postoperative Day 1 (POD1). The secondary outcomes were the time to return to consciousness, length of stay in the PACU, sedation score upon PACU arrival, pain, postoperative nausea and vomiting (PONV) and cumulative consumption of propofol and remifentanil. Adverse effects were recorded. RESULTS: The total QoR-40 scores (median, IQR) on POD1 decreased less (154.5, 152.0 -159.0) in Groups R and D (155.0, 154.8 -159.3) than in Group C (139.0, 136.8 -142.0) (P < 0.001). The time to return of consciousness and the length of stay in the PACU were significantly shorter in Groups R and C than in Group D (P < 0.001). The level of sedation upon PACU arrival (median, IQR) in Groups R (-2.0, -2.0--1.0) and D (-2.0, -3.0--2.0) was greater than that in Group C (1.0, 0.0 -1.0) (P < 0.001). The cumulative consumption rates of propofol and remifentanil in Groups R and D were lower than that in Group C (P < 0.001). Compared with that in Group C, the pain intensity was lower in Groups R and D (P < 0.001).The number of patients occurring PONV was less in Groups R (3/40) and D (4/40) than in Group C (11/40) (P = 0.024). Fifteen patients had bradycardia in Group D, whereas no bradycardia was noted in Groups R or C (P < 0.001). CONCLUSION: Administration of remimazolam could provide a similar QoR to that of dexmedetomidine. In addition, remimazolam may be a promising option for improving the QoR of patients who have undergone FESS. TRIAL REGISTRATION: ChiCTR2300076209. (Prospectively registered). The initial registration date was 27/9/2023.

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