A Comparison of the Efficacy of Cisatracurium and Atracurium in Kidney Transplantation Operation

Abstract

Cisatracurium is a new intermediate-acting benzylisoquinolinium neuromuscular blocking agent that is one of the ten stereoisomers contained in atracurium besylate. Atracurium is known to be the muscle relaxant of choice in end stage renal disease patients. This study aimed to compare the efficacy of cisatracurium and atracurium in the aspect of intubation and maintenance dosages, hemodynamic response after intubation and cost effectiveness between the two agents in kidney transplant patients. Material and Method: From August 2001 to July 2002, 46 end stage renal disease patients obtained kidney transplantation operation under general anesthesia with 50 : 50 N2O: O2, fentanyl, isoflurane anesthesia. Tracheal intubation and maintenance of muscle relaxant with each drug were administered in 23 of each group- atracurium as control (C) while cisatracurium was the study (S) group. Results: There was no difference in the demographic data of the 2 groups - 13 males/10 females in the S group and 11 males/12 females in the C group. Eighty-seven per cent in the S group underwent living-related kidney transplantation operation, with 55.56 per cent in the C group. Most of the donors were siblings, i.e. 42.11 per cent in the S group and 46.67 per cent in the C group. The mean dosage for intubation in the S group was 0.17 ± 0.02 mg/kg and 1.25 ± 0.49 μg/kg/ min for maintenance. The mean dosage for intubation in the C group was 0.64 ± 0.07 mg/kg and the mean maintenance dose was 5.38 ± 0.83 μg/kg/min. In both groups there was no statistical difference in hemodynamic changes. One patient in the S group received calcium channel blocker to reduce blood pressure before induction of anesthesia, while 2 patients in the C group were given nifedipine 5 mg before induction. Although the cisatracurium cost was higher than atracurium, from the cost-minimization analysis, it turned out to be lower per case. Conclusion: This study demonstrated the efficacy of cisatracurium in hemodynamic stability and safety in kidney transplantation operations. In spite of the more costly price, cisatracurium is beneficial in some end stage renal disease (ESRD) patients with coronary artery disease who need very stable hemodynamics.