A Comparison Between the Hemodynamic Effects of Cisatracurium and Atracurium in Patient with Low Function of Left Ventricle who are Candidate for Open Heart Surgery

Abstract

Background:The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered.Method:This study has been designed as a randomized prospective double-blind clinical trial. The target population included all adult patients with heart disease whose ejection fraction reported by echocardiography or cardiac catheterization was 35% or less before the surgery, and were candidate for open heart surgery in Shahid Rajaei Heart Center. Taking into account the inclusion and exclusion criteria, the patients were randomly placed in two groups of 30 people each. In the induction stage, all the patients received midazolam, etomidate, and one of the considered muscle relaxant, either 0.2 mg/kg of cisatracurium or 0.5mg/kg of Atracurium within one minute. In the maintenance stage of anesthesia, the patients were administered by infusion of midazolam, sufentanil and the same muscle relaxant used in the induction stage. The hemodynamic indexes were recorded and evaluated in different stages of anesthesia and surgery as well as prior to transfer to ICU.Results:In regard with descriptive indexes (age and sex distributions, premedication with cardiac drugs, ejection fraction before surgery, basic disease) there was no statistically significant difference between the groups.Conclusions:The significant difference of hemodynamic indexes between the two groups of this study, and the need for hemodynamic stability in all stages of surgery for patients with low function of left ventricle who are candidate for open heart surgery, proves that administering Cisatracurium as the muscle relaxant is advantageous and better.

Comparison of Dexmedetomidine, Lidocaine, and Fentanyl in Attenuation Hemodynamic Response of Laryngoscopy and Intubation in Patients Undergoing Cardiac Surgery

“…DAS et al [3], Ghorbanlo et al [13], Gogus et al in 2013 [11], Rani et al in 2016 [17], and Gunalan et al in 2015 [18] compared the effectiveness of fentanyl and dexmedetomidine in attenuating responses to laryngoscopy and intubation. According to the DAS results, dexmedetomidine was more effective than the fentanyl in preventing HR increase; however, fentanyl caused lower hypotension.…”

“…Although fentanyl has no significant effect on the cardiovascular system, it depends on the central vagus stimulation [ 13 , 14 ]. Opioids neutralize the hemodynamic responses to intubation and surgical stresses, but are associated with nausea, vomiting, and hypoventilation [ 15 ].…”

Effect of anaesthetic and choice of neuromuscular blocker on vagal control of heart rate under laboratory animal experimental conditions

“…29 This widens the applicability of our findings to both research studies necessitating neuromuscular blockade in animal models of disease which are susceptible to cardiovascular death, as well as to the use of neuromuscular blockers in the human population, for example to their use in patients undergoing cardiac surgery where haemodynamic stability is critical. 5 Nevertheless, a degree of caution is needed when using this agent alongside volatile anaesthetics. When administered under isoflurane anaesthesia, cisatracurium produced bradycardia and hypotension.…”

“…As such, neuromuscular blockers can cause haemodynamic changes through autonomic ganglion blockade and both vagolytic and sympathomimetic actions, potentially resulting in hypertension and tachycardia. 4–6 Nevertheless, different neuromuscular blocking agents can impact the cardiovascular system with varying potencies, 4,6 and clinically, the newer generation non-depolarizing neuromuscular blockers (e.g. rocuronium, vecuronium and cisatracurium) are reported to have fewer cardiovascular side-effects.…”

Comparison Between Hemodynamic Changes of Atracurium and Cisatracurium in Patients Undergoing Cabg Surgery

“…It is not associated with histamine release even in large doses 4,5 . All these characteristics of cisatracurium compared with atracurium make it a favorable choice for patients undergoing coronary artery bypass graft surgery as it causes less effects on hemodynamics 6,7 .…”