Comparative Clinical Pharmacology of Rocuronium, Cisatracurium, and Their Combination

Naguib, Mohamed; Samarkandi, Abdulhamid H.; Ammar, Adel; Elfaqih, S. R.; Al-Zahrani, Salem; Turkistani, Ahmed

doi:10.1097/00000542-199811000-00011

Cited by 39 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After the first incremental dose, duration T 20 was significantly shorter after rocuronium compared to cisatracurium, which is in accordance with the observations of others [7, 14]. Interestingly, we observed an increasing duration T 20 with repeated administration of rocuronium, albeit with a high duration T 20 variability, whereas the duration T 20 of cisatracurium remained constant and varied less, resulting after repeated administration in a significantly higher duration to recovery of the T4/T1 ratio in the rocuronium group.…”

Section: Discussionsupporting

confidence: 92%

Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium

et al. 2006

View full text Add to dashboard Cite

SummaryIn a randomised, controlled, double-blind, multicentre trial in 338 patients, we assessed the incidence of residual paralysis following administration of cisatracurium or rocuronium. The incidence at the end of surgery was significantly lower in patients treated with rocuronium (62 of 142 patients, 44%) than in those given cisatracurium (99 of 175 patients, 57%) (p < 0.05). In contrast, with rocuronium the mean (SD) time between skin closure and extubation was 28 (28) min vs 18 (19) min for cisatracurium, and the duration 0.9 (time from administration of last top-up dose to recovery of the train-of-four ratio to 0.9) was significantly longer and more variable for rocuronium than for cisatracurium. Thus, after repeated administration, the duration and variability of duration of action are greater with rocuronium compared with cisatracurium. These pharmacodynamic differences do not necessarily translate into a higher incidence of residual paralysis, because clinicians compensate for the longer duration of action and variability of rocuronium by terminating administration of the neuromuscular blocking earlier.

show abstract

Section: Discussionsupporting

confidence: 92%

Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Anaesthetics and the method of monitoring neuromuscular blockade affect determinations of potency and the onset and duration of action (Bartkowski et al. 1993; Naguib et al. 1998).…”

Section: Discussionmentioning

confidence: 99%

The clinical use of the neuromuscular blocking agent rocuronium in dogs

Dugdale

Adams

Jones

2002

Veterinary Anaesthesia and Analgesia

View full text Add to dashboard Cite

“…Tracheal intubation is required when the neuromuscular response is abolished, which is also an indication for laryngeal mask insertion. No consensus exists regarding the appropriate dose of muscle relaxant required for placing a laryngeal mask; the dose ranges from 1/10 dose to the full dose for normal tracheal intubation [18]. One study [18] also demonstrated that the dose of muscle relaxants required for laryngeal mask placement was smaller than that of the muscle relaxants required for endotracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

“…However, an overdose of cis-atracurium may increase the risk of aspiration, airway obstruction, and delayed recovery. The dosages of muscle relaxants used in trachea intubation vary greatly and range from 10 to 200 μg·kg − 1 [16][17][18][19]. However, a reasonable dosage of cis-atracurium under LMA has not been reported.…”

Section: Introductionmentioning

confidence: 99%

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

et al. 2020

View full text Add to dashboard Cite

Background: In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion.Methods: The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 μg·kg − 1 . The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and < 16 points indicated "satisfactory" and "unsatisfactory" responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from "satisfactory" and "unsatisfactory" responses. The primary outcome involved the determination of the median effective dose (ED50) of cis-atracurium for laryngeal mask airway insertion. Results:The median effective dose of cis-atracurium was 26.5 μg·kg − 1 (95% CI 23.6-29.8) using the sequential method. Heart rate was decreased in the 50 μg·kg − 1 group compared to that in the 30 μg·kg − 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 μg·kg − 1 group. Systolic blood pressure was decreased in the 50 μg·kg − 1 group compared to that in the 20 μg·kg − 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg − 1 group than in the 30 μg·kg − 1 group at timepoint T3 (P = 0.0326). Conclusions: The ED50 of cis-atracurium was 26.5 μg·kg − 1 for laryngeal mask airway insertion.

show abstract

Comparative Clinical Pharmacology of Rocuronium, Cisatracurium, and Their Combination

Abstract: Cisatracurium is four to five times more potent than rocuronium. Rocuronium had a faster onset of action, a shorter clinical duration, and a faster spontaneous recovery rate compared with equipotent doses of cisatracurium.

Cited by 39 publications

References 18 publications

Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium

Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium

The clinical use of the neuromuscular blocking agent rocuronium in dogs

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

Contact Info

Product

Resources

About