title: A Comparison Between the Hemodynamic Effects of Cisatracurium and Atracurium in Patient with Low Function of Left Ventricle who are Candidate for Open Heart Surgery.
abstract: BACKGROUND
  The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered.
  
  
  METHODS
  This study has been designed as a randomized prospective double-blind clinical trial. The target population included all adult patients with heart disease whose ejection fraction reported by echocardiography or cardiac catheterization was 35% or less before the surgery, and were candidate for open heart surgery in Shahid Rajaei Heart Center. Taking into account the inclusion and exclusion criteria, the patients were randomly placed in two groups of 30 people each. In the induction stage, all the patients received midazolam, etomidate, and one of the considered muscle relaxant, either 0.2 mg/kg of cisatracurium or 0.5mg/kg of Atracurium within one minute. In the maintenance stage of anesthesia, the patients were administered by infusion of midazolam, sufentanil and the same muscle relaxant used in the induction stage. The hemodynamic indexes were recorded and evaluated in different stages of anesthesia and surgery as well as prior to transfer to ICU.
  
  
  RESULTS
  In regard with descriptive indexes (age and sex distributions, premedication with cardiac drugs, ejection fraction before surgery, basic disease) there was no statistically significant difference between the groups.
  
  
  CONCLUSIONS
  The significant difference of hemodynamic indexes between the two groups of this study, and the need for hemodynamic stability in all stages of surgery for patients with low function of left ventricle who are candidate for open heart surgery, proves that administering Cisatracurium as the muscle relaxant is advantageous and better.
authors.affiliation: Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Ghorbanlo
authors.affiliation: Anesthesia and Critical Care Department, Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahmoud Reza
authors.initials: MR
authors.lastname: Mohaghegh
authors.affiliation: Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Forozan
authors.initials: F
authors.lastname: Yazdanian
authors.affiliation: Hasheminejad Kidey Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Mesbah
authors.affiliation: Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Totonchi
mesh_terms: D000368:Aged; D001279:Atracurium / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology* / Q000601:surgery
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium
keywords: Atracurium; Cisatracurium; low function of left ventricle; muscle relaxant; open heart surgery