Randomized Prospective Study to Compare Two Different Doses of Cisatracurium using Train of Four Neuro-Muscular Monitoring Regarding Intubating Conditions and Hemodynamic Parameters

Background: Cisatracurium, a non-depolarizing neuromuscular blocking agent, is commonly used during general anaesthesia to facilitate tracheal intubation. However, determining the optimal dosing regimen to achieve favorable intubation conditions with minimal hemodynamic disturbances is essential for safer anaesthesia practice. Neuromuscular function monitoring through Train of Four (TOF) provides a reliable way to assess the depth of blockade and ensure smooth intubation. Aims and Objectives: The primary objective of this study was to compare the effects of two different doses of cisatracurium (0.15 mg/kg and 0.20 mg/kg) on intubating conditions, including jaw relaxation, vocal cord mobility, and ease of laryngoscopy, along with the hemodynamic parameters such as blood pressure, heart rate, and oxygen saturation, using TOF neuromuscular monitoring. Materials and Methods: This was a prospective, randomized, double-blinded clinical study conducted at the Department of Anaesthesiology, LLRM Medical College & SVBP Hospital, Meerut, India, over 18 months. A total of 80 patients, aged 18 to 65 years, classified as ASA I and II, were randomly divided into two groups of 40 patients each. Group A received 0.15 mg/kg of cisatracurium, while Group B received 0.20 mg/kg. TOF monitoring was used to assess neuromuscular blockade at intervals after drug administration, and intubation conditions were scored based on jaw relaxation, vocal cord mobility, and laryngoscopy ease. Hemodynamic parameters were recorded pre- and post-intubation. Results: Patients in Group B (0.20 mg/kg) had significantly better intubating conditions, with 90% exhibiting easy jaw relaxation compared to 65% in Group A. Vocal cord mobility was better in Group B, with 90% of patients showing open vocal cords, compared to 68% in Group A. Laryngoscopy was easier in Group B (90% easy cases vs. 73% in Group A). Hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, and oxygen saturation showed no significant differences between the groups. Group B had a significantly shorter onset time of blockade (154.4 seconds vs. 180.63 seconds) and a longer duration of blockade (41.58 minutes vs. 27.75 minutes). Conclusion: Increasing the dose of cisatracurium from 0.15 mg/kg to 0.20 mg/kg improves intubation conditions without significant adverse hemodynamic effects. The higher dose provides faster onset and prolonged neuromuscular blockade, making it a more effective choice for achieving optimal intubation conditions.