(S-21) Viegas, O.J., Tuesday 7:00
TITLE: ROCURONIUM AND ATRACURIUM: CLINICAL EFFECTIVENESS AND SAFETY
AUTHORS: Oscar J. Viegas, MD1, Scott Groudine, MD2
AFFILIATION: 1Indiana University, Indianapolis, IN; 2Albany Medical Center, Albany, NY.
INTRODUCTION: Newer non-depolarizing can be used as substitutes for succinylcholine in outpatient surgery. In this study we compare the neuromuscular parameters, clinical responses and safety of rocuronium bromide and atracurium besylate in patients undergoing elective outpatient surgery.
METHODS: 40 patients ASA 1,2,3 participated in this open- label, randomized, multicenter study. Anesthesia was induced with 1-2mg/kg propofol followed for maintenance by inhalation of 60% nitrous oxide in oxygen and either sevoflurane or desflurane at clinically indicated inspired concentrations. Ventilation was assisted or controlled to maintain ETCO2 at 32- 40 mmHg. Within 2 minutes of obtaining stable baseline TOF response intubating dose of rocuronium (450ug/kg) or atracurium (500ug/kg) was administered as a rapid 5-second bolus. Patients were intubated 60 seconds after administration of the neuromuscular blocker with a second attempt at 90 seconds if first attempt was unsuccessful. Neostigmine/glycopyrollate combination was used for reversal of neuromuscular blockade. Onset time, time to 80% block and clinical duration were recorded. Also assessed were adverse experiences such as cutaneous reactions and cardiovascular changes.
RESULTS:
|
Efficacy Parameter |
Treatment Regimen |
p Value |
||||
|
Roc/ Sevo |
Roc/ Des |
Atra/ Sevo |
Atra/ Des |
Relaxant |
Anesthetic |
|
|
Time to 80%Block (sec)> |
119.9± 45.0 |
133.5 ± 57.5 |
146.7 ± 78.4 |
155.0 ± 45.6 |
0.21 |
0.57 |
|
Clinical Duration (min) |
30.3 ± 15.2 |
28.6 ± 15.4 |
35.4 ± 14.4 |
29.2 ± 10.7b |
0.57 |
0.37 |
|
Onset Time (sec) |
254.9 ± 99.5 |
237.1 ± 99.3 |
224.4 ± 85.9 |
254.0 ± 89.9 |
0.81 |
0.83 |
|
Time to Completion of Intubation (sec) |
144.7 ± 52.3 |
121.9 ± 51.6 |
126.7 ± 71.9 |
132.3 ± 56.7 |
0.85 |
0.66 |
aResultsare expressed as mean ± SD; n= 10/group
bn= 9
A total of 23 adverse events consisting of mild nausea, and rash following atracurium were experienced by eighteen patients.
CONCLUSION: Clinical effectiveness of rocuronium and atracurium are similar. A lower dose of rocuronium was needed to achieve these similar results and atracurium is known to have adverse effects associated with histamine release.