Comparative Study of the Use of Cisatracurium and Atracurium in Children under General Anaesthesia

Abstract

Background: Cisatracurium and atracurium are intermediate-acting muscle relaxants without many side effects due to non-organ-dependentnon-organ-dependent Hoffmann elimination. Cisatracurium in clinical practice is more potent and devoid of histamine-related side effects than atracurium but its use in children is limited.

Objective: To compare cisatracurium and atracurium in children regarding the onset, intubating conditions, duration of action, and reversibility of neuromuscular blockades.

Methods: This study was a prospective, randomised, double-blinded study on 83 children aged 2-7 years belonging to ASA I and II who were allocated into two groups of 42 patients in Group I and 41 in Group II. Group I received Cisatracurium 0.15mg/kg as the loading dose and 0.03mg/kg as the maintenance dose. In comparison, Group II received Atracurium 0.5mg/kg as the loading dose and 0.1mg/kg as the maintenance dose. The maintenance dose of neuromuscular blocking agent was given after 25% recovery of initial TOF value. The onset time, duration of block and recovery index were recorded using a train of four responses and a haemodynamic profile.

Results: The difference in mean onset time was significant among the two groups (2.47±0.59 minutes vs. 2.12±0.62minutes in the cisatracurium and atracurium groups, respectively). The mean duration of action of cisatracurium was also significantly longer (47.03±9.15 minutes) compared to that of the atracurium group (27.90±9.73 minutes). Both groups had excellent intubating conditions; haemodynamics and reversibility time were also comparable.

Conclusion: Cisatracurium is also a potent neuromuscular blocker in comparison to atracurium, which can be used safely in children undergoing surgeries of more than 45 minutes duration.