Effective doses of cisatracurium in the adult and the elderly

Abstract

BackgroundThere are few information about the differences of the effective dose (ED) of cisatracurium between the adult and the elderly. We investigated the ED and the onset time of cisatracurium in the adults and the elderly.MethodsWe studied two hundred patients of the adults aged 20 through 64 years and the elderly aged ≥ 65 years, with American Society of Anesthesiologists physical status I or II. Each 100 patients with 20 patients of each dose group, randomly selected from 30, 40, 50, 60 or 70 µg/kg of cisatracurium, were randomly allocated to the adults and the elderly groups. We recorded the 0.1 Hz single twitch responses of the adductor pollicis and the onset times to maximal blockade. The magnitude of muscle relaxation was recorded by using an acceleromyography. The effect of cisatracurium on single twitch was calculated as percent reduction. After converting each drug dose into logarithm and percent reduction of the muscle reduction into probit, the EDs representing the muscle relaxation effects of 5%, 25%, 50%, 75% and 95% were estimated using the linear regression analysis.ResultsNo significant differences were found in age, weight, height, or body mass index within or between the groups. The ED50 and ED95 of the adult group were 35.39 and 59.58 µg/kg. The ED50 and ED95 of the elderly group were 34.89 and 55.50 µg/kg, respectively. The onset times were 375.4 ± 76.9 seconds in the adult group and 369.1 ± 70.0 seconds in the elderly group.ConclusionsThe ED and the onset time were not significantly different between the adult and the elderly.

Abnormal Cisatracurium Pharmacodynamics and Pharmacokinetics among Patients with Severe Aortic Regurgitation during Anesthetic Induction

“…On the contrary, PK parameters evaluating drug elimination such as K 10 ,K 20 and T 1/2β were unaltered statistically in the AR group. This finding is consistent with the fact that cisatracurium metabolises mainly by pH-and temperature-dependent Hofmann reaction [4,14] . Abnormal hemodynamics in severe AR patients could contribute to markedly altered distribution of cisatracurium but could not affect its elimination condition.…”

Perfil clínico-epidemiológico de pacientes cirúrgicos com ressecamento ocular e risco de ressecamento ocular

“…Para ambos os grupos de pacientes, a frequência expressiva do uso do cisatracúrio como tipo de miorrelaxante está em conformidade com investigação científica internacional, a qual identificou a utilização deste relaxante muscular em associação com a anestesia geral, o qual também possui propriedades que impedem a movimentação ocular e fechamento palpebral (17) , o que pode caracterizá-los como fatores que favorecem o ressecamento ocular.…”

“…Em contrapartida, estudo sobre o efeito do cisatracúrio em adultos e idosos comenta que o uso deste relaxante não promove aumento considerado da histamina, mediador químico envolvido na inflamação (17) . Esta característica pode ser considerada fator de proteção para o desenvolvimento do ressecamento ocular, uma vez que fatores inflamatórios na região dos olhos são desencadeadores de alterações oculares (15) .…”

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

“…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.…”