جستجوی مقالات مرتبط با کلیدواژه "neuromuscular blocking agents" در نشریات گروه "پزشکی"

Muscle relaxants are used for two general purposes. One is to ease endotracheal intubation, and the other is provide surgical relaxation.
This study has been designed with the aim of assessing the impact of atracurium and cisatracurium on patients at the anesthesia induction and the neutrophil to lymphocyte ratio.

This is a randomized clinical trial that was performed in 2022-2023 in Kashani hospital in Isfahan, Iran on patients that were candidates for elective surgery under general anesthesia by atracurium or cisatracurium. A total number of 80 patients entered and were randomized into two group’s one receiving group atracurium 0.5mg/kg, and other group received cisatracurium 0.15mg/kg over 60 seconds as NMB. Blood sample were taken base time, after 3, and 20 minutes following intubation. Qualitative data is reported as frequency with percentage. And quantitative data as average with standard deviation. Statistical analysis was done using SPSS version 25. Qualitative data were analyzed using chi-square tests and quantitative data using independent T test. Significance level was defined as p value <0.05.

Overall, 80 patients were enrolled in this study. 40 of them belonged to the cisatracurium group and 40 to the atracurium group. Average age of the participants was 42.86 (±14.52) years old. Mean arterial pressure (MAP) in cisatracurium group dropped significantly following intubation (p<0.005), while it rose significantly in the atracurium group (p<0.05). However neutrophil to lymphocyte ratio (NLR) was significantly higher in the cisatracurium group following intubation (P<0.05).

While the use of atracurium in patients is still safe, is yet more correlated with pronounced hemodynamic instability compared to cisatracurium.

The entropy electrode is centrally placed on the forehead over the muscles of frontalis, orbicularis oculi, and corrugator supercilii. It determines response entropy (RE), which is the electromyogram component, and state entropy (SE), which is the electroencephalogram component. We hypothesized that due to the central location of entropy, the decreasing value of RE-SE  2 with SE  45 could denote an adequate combination of hypnosis, muscle paralysis, and analgesia required for endotracheal intubation. This could result in earlier intubation compared to when guided by train-of-four (TOF) = 0. The primary objective of the study was to evaluate if entropy values of RE-SE2 with SE45 can be used as a measure of adequate condition for endotracheal intubation. We also sought to determine the TOF at this point. Endotracheal intubation was performed in group E (Entropy; n = 30) at RE-SE  2 with SE  45 and in group T (TOF; n = 30) at TOF = 0. A propofol bolus (20 mg) was administered if the patient had a hypertensive response or moved in response to endotracheal intubation. The TOF was noted at the time of intubation in group E. We also measured the time to intubation, jaw and vocal cord relaxation, patient movement or coughing, SE, TOF, and vital parameters. Statistical analysis was performed with two-tailed students’ t test, paired t test, chi-square test, and ANOVA. The difference between groups was considered significant if the p value was < 0.05. The time to intubation was significantly shorter in group E than in group T (92.563.5 seconds vs. 209.259.6 seconds; P < 0.001) with a mean TOF of 87.3%  8.4% in group E. Intubating conditions in terms of jaw relaxation, patient movement, and coughing were not significantly different between the two groups. Vocal cord relaxation was significantly inadequate in six patients in group E (P < 0.01); however, there was no difficulty in introducing the endotracheal tube with no postoperative adverse effects such as sore throat. Adequate conditions for endotracheal intubation were achieved 90 seconds after the administration of fentanyl, propofol, and vecuronium for anesthesia induction when it is guided by RE-SE2 with SE45, which is earlier than when guided by TOF = 0.