Consumption of Cisatracurium in different age groups, using a closed loop computer controlled system

Abstract

BackgroundWe devised this study to quantify the effect of age on the consumption of cisatracurium under general anaesthesia, using a computer controlled closed loop infusion system. We further investigated this effect on, sufentanil and propofol consumption.Methods74 patients of physical status I and II, requiring general anaesthesia for elective abdominal surgery, were assigned to three groups. Patients in group 1 were aged from 20 to 45, group 2 were from 46 to 64, and group 3 above 65 years old. General Anesthesia was maintained with propofol and muscle paralysis was maintained using a closed-loop computer controlled infusion of cisatracurium. For analgesia, intermittent bolus of sufentanil 10 μg was given.ResultsCisatracurium consumption in group 1, 2 and 3 were 1.8 ± 0.3, 1.6 ± 0.4 and 1.3 ± 0.4 μg/kg/min respectively. There was significant difference of cisatracurium consumption between group 1 and 3 (P = 0.002), and the consumption of cisatracurium in group 3 was less as compared with group 2 (P = 0.04). The average recovery index of patients in group 1, 2 and 3 were 8.8 ± 2.6, 11.5 ± 2.9 and 12.7 ± 2.5 minutes respectively. There were difference between group 1 and 2 (P = 0.02). As compared with group 1, the recovery index was still longer in group 3 (P = 0.001). Patients in group 1, 2 and 3 consumed an average sufentanil 0.4 ± 0.1, 0.4 ± 0.1 and 0.3 ± 0.1 μg/kg/hr, respectively. There were statistical significant between group 1 and 3 (P < 0.0001), and the same trend was found between group 2 and 3 (P = 0.03). The Consumption of propofol in group 1, 2 and 3 were 5.1 ± 0.4, 4.3 ± 0.6 and 3.1 ± 0.5 mg/kg/hr. The difference in the propofol consumption was found statistically significant when comparing between any two groups.ConclusionWe concluded that the sensitivity of anesthetic agents increased with age. Less medication was required to achieve a desirable effect in older patients specially those above 65 years of age, and the drug effect was prolonged.Trial registrationClinicalTrials.gov Identifier: NCT01785446.

Effective doses of cisatracurium in the adult and the elderly

“…However, Joomye et al [ 20 ] studied cisatracurium consumption and recovery index by age group—20–45, 46–64 and ≥ 65 years—and there were significant differences between the groups aged 20–45 and ≥ 65 years, likely because of the reduced body fluid that accompanies aging and that results in increased serum blood drug concentrations and increased volume of distribution due to increased body fat; the authors of that study suggested that the elderly require less cisatracurium to achieve a desirable effect. Although those authors reached their conclusion using consumption and recovery indexes with a closed-loop computer-controlled infusion, we investigated the cisatracurium ED and onset time with a single bolus.…”

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

“…Although interindividual variability of block duration in response to benzylisoquinoline muscle relaxants is thought to have no clinical significance, a study performed by Joomy et al [35] seems to contradict this belief. The authors used a closed feedback loop devised to control cisatracurium administration with electromyographic response of the muscle.…”