Comparison of Intubation Conditions of Cisatracurium with and without a Priming Dose in Patients under General Anaesthesia: A Randomised Controlled Trial

Introduction: Endotracheal intubation is a crucial procedure during general anaesthesia that maintain a patent airway and facilitate mechanical ventilation. Cisatracurium, a benzylisoquinolinium non depolarising neuromuscular blocker, offers advantages such as a predictable duration of action and organ-independent metabolism; however, it has a relatively delayed onset. Priming with a subparalysing dose may expedite the onset and improve intubating conditions. Aim: To compare the intubating conditions of cisatracurium with and without a priming dose in patients undergoing general anaesthesia. Materials and Methods: This randomised controlled trial was conducted from July 2023 to July 2025 at Department of Anaesthesia, Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India. After obtaining informed consent, 60 American Society of Anaesthesiologists (ASA) physical status I-II patients undergoing elective surgeries were enrolled. Patients were randomised and single-blinded into two groups: Group C (cisatracurium intubating dose of 0.15 mg/kg) and Group CP (a priming dose of one-fifth of 0.15 mg/kg followed by the remaining dose for intubation). The onset of neuromuscular blockade, intubating conditions, haemodynamic parameters, and adverse events were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, applying Independent samples t-tests and Chi-square tests, with p-value <0.05 considered statistically significant. Results: The demographic characteristics of the study population were comparable between Group CP (cisatracurium with priming) and Group C (cisatracurium without priming). There was no significant difference in age distribution between the two groups. Group CP demonstrated a significantly faster onset of neuromuscular blockade (116.8±13.58 seconds) compared to Group C (180.63±13.47 seconds; p-value <0.01). The duration of action was significantly shorter in Group CP (29.87±5.01 minutes) than in Group C (35.60±4.44 minutes; p-value <0.01). Ease of laryngoscopy and favourable vocal cord positioning were significantly better in Group CP (p-value=0.003 and p-value=0.0049, respectively). Haemodynamic stability and the incidence of adverse events were comparable between the groups. Conclusion: Priming with cisatracurium effectively enhances intubating conditions and shortens the onset time without compromising haemodynamic stability. It represents a safe and reliable modification in anaesthesia practice for achieving smooth and rapid intubation.