The Comparative Study Of Three Methods In Accelerating The Onset Time Of Cisatracurium

Objective: To provide theoretical reference for clinical rational use of cisatracurium with the analysis of three methods in accelerating the onset time of cisatracurium.Methods: We selected 120 patients who were scheduled to undergo elective surgery under general anesthesia.All the patients conditioned:American Society of anesthesiologists(ASA)rating of stage I ~ II,age: 18 to 65 years old,body mass index(BMI):18.5 ~ 24.9kg/m2,Mallampati grade I ~ II,no difficult airway and no high risk of reflux and aspiration,no fever,no severe anemia,no drugs and food allergies,no liver/kidney/heart and lung system disease,not taking drugs recently with the influence of muscle relaxant effect,no preoperative severe high blood pressure,heart rate :60-110 times /min,no surgery/trauma or puncture of the monitoring site at recent 3 months before the operation.With the method of random number table,120 subjects were randomly divided into 4 groups,the control group(Group C),rocuronium pre injection group(Group R),combined with ephedrine group(E group)and large dose group(group L).Each group contain 30 cases.Each group patients’ general anesthesia were induced by intravenous injection of penehyclidine hydrochloride 0.01 mg/kg,midazolam 0.05 mg/kg,fentanyl 4 mu g/kg,and the muscle relaxant monitoring scale was completed after the patient consciousness disappeared.R group,E group were treated with rocuronium 0.06mg/kg or ephedrine 70 g/kg.C group and L group were given 0.9%Nacl as control group,and four gropes were given in the same time with etomidate 0.3 mg/kg,Finally,group C,group R,group E and group cis were given intravenous injection of 0.15mg/kg,0.14mg/kg,0.15mg/kg,0.20mg/kg and L respectively with the train of four stimulation mode(TOF)to monitor the changes of muscle relaxation.Anesthesia was maintained by intravenous pumping of remifentanil(0.025 to 0.4 g kg-1 min-1)and propofol(4~12 mg kg-1 h-1),inhaling sevoflurane(0.6 to 1 MAC).Mean arterial pressure(MAP),heart rate(HR),arterial oxygen saturation(Sp O2)were recorded after stable admission(T1),tracheal intubation(T2),immediate intubation(T3),tracheal intubation,1min(T4),2min(T5),3min(T6),4min(T7),5min(T8).Record onset time(from cisatracurium inject finish to TOF=0),duration(from cisatracurium inject finish to TOF =2),endotracheal intubation TOF;rating endotracheal intubation conditions,calculate intubation conditions,observe patients during anesthesia induction and maintenance,if they are have allergic reactions such as: the skin and subcutaneous tissue abnormalities(macula,erythema,urticaria,skin flush,etc),trachea,bronchospasm,and the phenomenon such as arrhythmia.Results: 104 patients were included in this trail finally(C=27,R=25,E=27,L=25).Age,BMI,preoperative temperature,gender had no difference in each group(P>0.05).On different times,The MAP,HR,Sp O2 had statistically different during the period of perioperation in four groups(P<0.05).The MAP and HR on T3 were higher than others in four groups.Compare with group R,The MAP on T3 of group E was higher,the HR on T2 and T8 were lower than the one of T1.The Sp O2 on T1 was lower than others in four groups.Different random grouping have no effect on MAP、HR、Sp O2 at different time points.There was no difference between each group on the variational trend.Compare with group C,the onset time of other groups were signifficantly shorter(P<0.05),and group R was obviously faster than group E(P<0.05).There was no difference between group R and group L.The cisatracurium duration of group L was longest in the four groups(P<0.05).There was no difference in group C、group R and group E about duration.The TOF ratio of group R at the time of intubation was lowest in four groups(P<0.05).Comparing with group L,the group E and group C were higher,and there was no different in the two groups.The intubating condition is no different between each group(P>0.05).No skin erythema.Bronchospasm and arrhythmia were occured during perioperation.Conclusion: Rocuronium priming,combined with methamphetamine,dose increasing principle can significantly increase the onset time of cisatracurium,all can get better conditions for intubation.In which the onset time of the rocuronium priming is the best,and can get optimal intubation conditions,induction period smoothly,no significant adverse reactions,can be used in clinical by most patients.