Aims: To compare neuromuscular blockade and recovery characteristics of cisatracurium and atracurium in adult patients. Methodology: 60 patients, 18-65 years, ASA class I &II for surgery under general anesthesia were randomly allocated to cis-atracurium and atracurium group. After induction agent, dose of neuromuscular blocking drug (NMBA) atracurium 0.5mg/kg loading and maintenance dose of 0.1mg/kg or cisatracurium ,0.2mg/kg and maintenance dose of 0.03mg/kg was given to the patients. The onset time was determined as the interval from the end of muscle relaxant injection until "Train of four (TOF) score 0". Neuromuscular monitoring was carried out at every 15s to stimulate the ulnar nerve via surface electrodes. Duration from the last dose of NMBA to 25% recovery of TOF was recorded. Results: Mean Duration of action (DOA) of 1 ST dose in Cisatracurium group was 61.50 minute which was significantly more as compared to 38.57 minute in Atracurium group. Recovery from last dose in Cisatracurium group was 48.73 minutes, 33.63 minutes in Atracurium group and difference was statistically significant. Conclusion: Intubating conditions were achieved faster & duration of action was longer with loading dose cisatracurium than atracurium. Between neostigmine administration and attaining a TOF ratio of 80%, time duration was shorter with cisatracurium than atracurium, when administered at TOF 25%.
Myaesthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness that worsens with exertion and improves after a period of rest Keywords: myasthenia gravis, respiratory muscle weakness, anticholinesterase medicationCase Report A 78year old male, weighing 65kgs, known case of myasthenia gravis (Osserman IIa) presented for cholecystectomy with CBD exploration. He was on tablet. Pyridostigmine 60 mg twice daily. He had been treated conservatively for cholangitis and had undergone endoscopic retrograde cholangio pancreaticography (ERCP) with biliary stenting ten days prior. Other complaints included urinary incontinence (for which he was on tab. Urimax-D once daily) and dyspnoea on exertion (NYHA grade II). General and systemic examination were unremarkable except for pallor and decreased breath-holding time(~12-13seconds).Airway examination revealed anticipated difficult intubation due to heavy jaw, Mallampatti grade III and multiple artificial fixed dentures in both jaws. Routine haematological investigations were within normal limits except haemoglobin 8.0gm%.He had left anterior hemiblock on ECG and moderate obstruction on pulmonary function test (PFT). Chest radiograph revealed increased broncho-vascular markings with few calcific granulomas. Echocardiography showed ejection fraction 55% with diastolic dysfunction and concentric left ventricular hypertrophy. The patient was taken up for surgery after correcting anaemia and optimizing with nebulisations. High risk consent was taken and ICU bed and ventilator were kept available.
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