Comparative Study of Neuromuscular Blocking Effects of Atracurium and Cisatracurium in Pediatric Patients Undergoing Elective Surgery Under General Anaesthesia

Abstract

Background: Neuromuscular blocking agents (NMBAs) are integral part of pediatric anesthesia, in facilitating endotracheal intubation and providing muscle relaxation during surgery. Atracurium and Cisatracurium are commonly used non- depolarizing NMBAs, each with distinct pharmacological profiles. Aim of the study is to compare the neuromuscular blocking effects of Atracurium and Cisatracurium in pediatric patients undergoing elective surgery under general anaesthesia using neuromuscular monitoring [TOF].

Methods:   Prospective, randomized controlled trial, 60 pediatric patients aged 1-12 years undergoing elective surgery under general anesthesia were randomly assigned to receive either Atracurium (0.5 mg/kg) or Cisatracurium (0.15 mg/kg) intravenously. Neuromuscular function was monitored using Train-of-Four (TOF). The primary outcomes measured were onset and  duration of neuromuscular blocking effect using TOF monitor and quality of tracheal intubation. Secondary outcomes included were hemodynamic stability and the incidence of adverse effects.

 Results: The research participants in both the groups had comparable characteristics with regards to demographic profile including the age, weight and gender distribution.The onset time for neuromuscular blockade was significantly faster with cisatracurium (2.6 ± 0.49 minutes) compared to atracurium (4.3 ± 0.46 minutes) (p < 0.001). The duration of neuromuscular blockade was significantly longer with cisatracurium (54.9 ± 3.2 minutes) than atracurium (27.8 ± 1.3 minutes) (p < 0.001). The time to recovery from neuromuscular blockade was significantly shorter with atracurium (27.4 ± 1.5 minutes) compared to cisatracurium (37.8 ± 1.1 minutes) (p < 0.001). Cisatracurium provided better intubating conditions, with a higher proportion of patients achieving excellent Cooper scores (90% vs. 66.7% for atracurium) (p < 0.05). Hemodynamic parameters and side effects were comparable between the two groups.

 Conclusion: Both Atracurium and Cisatracurium are effective for neuromuscular blockade in pediatric patients. Cisatracurium had a quicker onset, longer duration of action, better intubating conditions and superior cardiovascular stability with minimal side effects although  atracurium had a rapid recovery profile.  Hence Cisatracurium is considered a preferable choice in pediatric patients for longer procedures or with cardiovascular concerns.