A comparison of cisatracurium (51W89) and atracurium by infusion in critically ill patients.
OBJECTIVE
To evaluate and compare the safety and efficacy of cisatracurium (51W89) and atracurium administered by continuous infusion to critically ill patients requiring neuromuscular blocking agents to facilitate mechanical ventilation.


METHODS
Open, randomized, multicenter study of patients receiving cisatracurium or atracurium infusion to facilitate mechanical ventilation.


METHODS
Five university teaching hospital intensive care units in the United Kingdom.


METHODS
Sixty-one adult patients requiring neuromuscular blocking agents to facilitate mechanical ventilation.


METHODS
Bolus doses followed by continuous infusions of cisatracurium or atracurium were administered. Onset, maintenance, and recovery of neuromuscular blockade were measured, using transcutaneous ulnar nerve stimulation and an accelerometer.


RESULTS
Forty patients received cisatracurium (mean duration 48.1 +/- 4.2 [SEM] hrs), and 21 patients received atracurium (mean duration 46.1 +/- 5.8 hrs). The infusion rate for patients receiving cisatracurium was 3.1 +/- 0.2 microg/kg/min, and for patients receiving atracurium 10.4 +/- 0.9 microg/kg/min. There were no significant differences in mean times to 70% recovery of Train-of-Four ratio (cisatracurium 60 mins, atracurium 57 mins), although there was considerable interpatient variation (20 to 175 mins with cisatracurium vs. 35 to 85 mins with atracurium). One patient who received cisatracurium exhibited intermittent bronchospasm during and after the study period.


CONCLUSIONS
Cisatracurium, an isomer of atracurium, appears to be a suitable agent for providing muscle relaxation in critically ill patients.
Newman
P J
PJ
St. George's Hospital, London, UK.
Quinn
A C
AC
Grounds
R M
RM
Hunter
J M
JM
Boyd
A H
AH
Eastwood
N B
NB
Pollard
B J
BJ
Pearson
A J
AJ
Harper
N J
NJ
Beale
R J
RJ
Sutjarittam
M
M
Elliot
J M
JM
Bion
J F
JF
D018806:APACHE; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium