title: Cost analysis and safety comparison of Cisatracurium and Atracurium in patients undergoing general anesthesia.
abstract: BACKGROUND
  Non-depolarizing neuromuscular blocking agents (NMB) differ in pharmacokinetic and pharmacodynamic parameters. An anesthesiologist according to these similarities and differences is able to choose the least costly one if the same safety profile and same clinical benefit achieved with the different alternatives.
  
  
  OBJECTIVE
  The main objective of this study is to evaluate the economic and adverse drug reactions prevalence and differences between cisatracurium and atracurium the two non-depolarizing NMB drugs, which are widely used in adult patients undergoing surgery with general anesthesia in a teaching Hospital in Iran.
  
  
  METHODS
  A cost analysis and adverse drug reactions (ADR) monitoring were performed. Only direct costs were considered and data were collected through a prospective randomized study. Regardless of the type of surgery, 100 patients were randomly divided into two equal groups to receive either cisatracurium or atracurium by anesthesiologists. ADRs prevalence and cost differences between patients receiving one of the two non-depolarizing NMB agents were evaluated by independent sample t-test and Chi-square test respectively.
  
  
  RESULTS
  No significant difference was observed between the two groups of patients in demographic data. There was no statistical difference in the ADR prevalence in both groups. The numbers of ADR within atracurium group was higher than cisatracurium group, but this distinction was not statistically significant (p > 0.05). It was significant difference in cost between the two neuromuscular blocking drugs (p < 0.05).
  
  
  CONCLUSIONS
  According to our study it seems that atracurium and cisatracurium had similar safety profile and atracurium had a cost benefit relative to cisatracurium in initial loading doses. In patients with instability in hemodynamic parameters the cisatracurium was the appropriate choice.
authors.affiliation: Department of Anesthesiology and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Movafegh
authors.forename: S
authors.initials: S
authors.lastname: Amini
authors.forename: H
authors.initials: H
authors.lastname: Sharifnia
authors.forename: H
authors.initials: H
authors.lastname: Torkamandi
authors.forename: A
authors.initials: A
authors.lastname: Hayatshahi
authors.forename: M
authors.initials: M
authors.lastname: Javadi
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D001279:Atracurium / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; C101584:cisatracurium