Effect of different doses of cisatracurium on intraocular pressure in sedated patients

Effects of Cisatracurium, Rocuronium, and Mivacurium on Intraocular Pressure During Induction of General Anesthesia in Ophthalmic Surgery

Objective

Maintaining intraocular pressure (IOP) is important in preventing ocular complications in patients undergoing ophthalmic surgery for general anesthesia. The effects of non-depolarizing neuromuscular blockers on IOP remain unclear. The present study compared the effects of cisatracurium, rocuronium, and mivacurium on IOP during induction of general anesthesia in vitreous retinal surgery.

Materials and Methods

In this prospective randomized double-blinded study, 133 patients undergoing vitreous retinal surgery were randomized into one of the three groups: Group cisatracurium (n=45), Group rocuronium (n=44), or Group mivacurium (n=44). Each drug (cisatracurium 0.1 mg kg⁻¹ in Group cisatracurium, rocuronium 0.6 mg kg⁻¹ in Group rocuronium, and mivacurium 0.2 mg kg⁻¹ in Group mivacurium) was administered during induction of anesthesia. IOP and hemodynamic parameters were measured at 1 min before anesthesia induction (T0). Bispectral index (BIS) was maintained between 45 and 55 after propofol administration (T1). Train-of-four stimulation (TOF) was below 0 after muscle relaxant administration (T2) and after laryngeal mask implantation (T3).

Results

Both ipsi-operative and control-operative IOP at T1, T2, and T3 significantly decreased from the baseline values (T0) in all three groups (P<0.05). The IOP changes between T1 and T2 among three groups were similar (P>0.05). The values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1 and T2 significantly decreased in all three groups compared to T0 (P<0.05).

Conclusion

Bilateral IOP significantly decreased from the baseline values in all three groups during the induction phase. Cisatracurium, rocuronium, and mivacurium did not induce significant changes in bilateral IOP.

Effects of different doses of cisatracurium besilate on hemodynamics and postoperative cognitive function in patients undergoing radical resection of lung cancer

The effects of different doses of cisatracurium besilate on perioperative hemodynamics and early postoperative cognitive function in patients undergoing radical resection of lung cancer were investigated. One hundred and thirty-six patients who underwent radical resection of lung cancer from June 2013 to June 2016 in Dongying People's Hospital were retrospectively analyzed. Patients who were not given atracurium were selected as the control group (n=35). According to the different anesthetic doses, patients in the experimental group were separated into low dose (0.15 mg/kg cisatracurium besilate) group (LD group, n=34), medium dose (0.2 mg/kg cisatracurium besilate) group (MD group, n=36) and high dose (0.3 mg/kg cisatracurium besilate) group (HD group, n=31). The mean arterial pressure and heart rate (HR) were recorded before induction of anesthesia (T0), at the time of entering pleural cavity (T1), at the end of surgery (T2), and 1 day after surgery (T3). The Mini-Mental State Examination (MMSE) was used to evaluate the postoperative cognitive function scores of the 4 groups 1 day before operation and on the 1st, 3rd and 7th day after surgery. The agitation of patients at 6 and 12 h after operation was evaluated by Ramsay sedation score. There was no significant difference in arterial pressure among the four groups at T2 and T3 (P>0.05). There was no significant difference in terms of MMSE among the four groups 1 day before operation, 3 days after operation and 7 days after operation, but the MMSE score of the control group was significantly lower than that of the LD, MD and HD groups 1 day after surgery (P<0.05). Therefore, cisatracurium besilate can stabilize hemodynamics during radical operation of lung cancer and reduce the incidence of postoperative cognitive dysfunction, and it has no close association with the dose.

Autophagic Cell Death and Apoptosis Jointly Mediate Cisatracurium Besylate-Induced Cell Injury

Cisatracurium besylate is an ideal non-depolarizing muscle relaxant which is widely used in clinical application. However, some studies have suggested that cisatracurium besylate can affect cell proliferation. Moreover, its specific mechanism of action remains unclear. Here, we found that the number of GFP-LC3 (green fluoresent protein-light chain 3) positive autophagosomes and the rate of mitochondria fracture both increased significantly in drug-treated GFP-LC3 and MitoDsRed stable HeLa cells. Moreover, cisatracurium promoted the co-localization of LC3 and mitochondria and induced formation of autolysosomes. Levels of mitochondrial proteins decreased, which were reversed by the lysosome inhibitor Bafinomycin A1. Similar results with evidence of dose-dependent effects were found in both HeLa and Human Umbilical Vein Endothelial Cells (HUVECs). Cisatracurium lowered HUVEC viability to 0.16 (OD490) at 100 µM and to 0.05 (OD490) after 48 h in vitro; it increased the cell death rate to 56% at 100 µM and to 60% after 24 h in a concentration- and time-dependent manner (p < 0.01). Cell proliferation decreased significantly by four fold in Atg5 WT (wildtype) MEF (mouse embryonic fibroblast) (p < 0.01) but was unaffected in Atg5 KO (Knockout) MEF, even upon treatment with a high dose of cisatracurium. Cisatracurium induced significant increase in cell death of wild-type MEFs even in the presence of the apoptosis inhibitor zVAD. Thus, we conclude that activation of both the autophagic cell death and cell apoptosis pathways contributes to cisatracurium-mediated cell injury.

Xylazine Premedication does not Modify the Onset and Duration of Cisatracurium Blockade in Anaesthetized Dogs

The purpose of this study was to evaluate the effect of xylazine as premedication on the onset time and duration of cisatracurium neuromuscular blockade in anaesthetized dogs. This study was carried out on 12 healthy dogs aged 0.5-6 years and weighing 9-26 kg undergoing various elective surgical procedures. The dogs were randomly divided into two groups of t (test) and c (control), with six dogs each. In group t, premedication was conducted using acepromazine maleate 0.3 mg kg(-1) and xylazine 0.3 mg kg(-1) and in group c only acepromazine (same dose) was injected intramuscularly 20 min before general anaesthesia. After induction with thiopental, anaesthesia was maintained with halothane in oxygen to deliver an end-tidal halothane concentration of 1.1%. Neuromuscular blockade was induced with cisatracurium 0.2 mg kg(-1) and monitored using the train-of-four (TOF) stimulation pattern applied at the ulnar nerve. The onset time of cisatracurium blockade was 195 +/- 85.44 s in test and 153.3 +/- 38.16 s in control group. The duration of neuromuscular blockade was 24.8 +/- 4.79 min in t and 28.3 +/- 5.46 min in the c group. Statistical analysis of the data showed no significant difference between groups in terms of onset and duration of neuromuscular blockade.