title: Comparative clinical pharmacology of rocuronium, cisatracurium, and their combination.
abstract: BACKGROUND
  The comparative clinical pharmacology of cisatracurium and rocuronium and their combinations has not been reported. In this study, the authors compared the relative potency and the clinical profile and characterized the interaction of both drugs.
  
  
  METHODS
  Two hundred twenty adults classified as American Society of Anesthesiologists physical status I and anesthetized with propofol-fentanyl-nitrous oxide were studied. In part 1, the neuromuscular-blocking effects of cisatracurium and rocuronium were assessed after administration of bolus doses of 20-50 microg/kg and 100-300 microg/kg, respectively. In part 2, we compared the time course of 1xED50, 1, 1.5, and 2xED95 doses of both drugs (where ED50 and ED95 are, respectively, the doses producing 50% and 95% depression of the first twitch height [T1]). In part 3, equieffective combinations of both drugs were studied to characterize their interaction.
  
  
  RESULTS
  The calculated ED50 values and their 95% confidence intervals were 111 (107-115) and 26.2 (25.8-26.5) microg/kg [corrected] for rocuronium and cisatracurium, respectively. Compared with equipotent doses of cisatracurium, rocuronium had a faster onset, and a faster spontaneous T1 and train-of-four recovery times that were significant except at maximum recovery with the 2xED95 dose. The interaction between rocuronium and cisatracurium was synergistic, and the time profile of the combination group was different from that of the single-dose groups.
  
  
  CONCLUSIONS
  Cisatracurium is four to five times more potent than rocuronium. Rocuronium had a faster onset of action, a shorter clinical duration, and a faster spontaneous recovery rate compared with equipotent doses of cisatracurium.
authors.affiliation: Department of Anesthesiology, King Saud University, College of Medicine at King Khalid University Hospital, Riyadh, Saudi Arabia. naguib01@ksu.edu.sa
authors.forename: M
authors.initials: M
authors.lastname: Naguib
authors.forename: A H
authors.initials: AH
authors.lastname: Samarkandi
authors.forename: A
authors.initials: A
authors.lastname: Ammar
authors.forename: S R
authors.initials: SR
authors.lastname: Elfaqih
authors.forename: S
authors.initials: S
authors.lastname: Al-Zahrani
authors.forename: A
authors.initials: A
authors.lastname: Turkistani
mesh_terms: D000328:Adult; D000732:Androstanols / Q000493:pharmacokinetics; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000031:analogs & derivatives* / Q000493:pharmacokinetics*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004347:Drug Interactions; D005260:Female; D005283:Fentanyl; D006801:Humans; D008297:Male; D009294:Narcotics; D009466:Neuromuscular Blocking Agents / Q000493:pharmacokinetics; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics; D009609:Nitrous Oxide; D015742:Propofol; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D009294:Narcotics; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009609:Nitrous Oxide; C101584:cisatracurium; D005283:Fentanyl; D000077123:Rocuronium; D015742:Propofol