Comparison of Cisatracurium and Atracurium on Intubating Conditions and Haemodynamic Responses during Laryngoscopy in Patients Undergoing General Anaesthesia: A Randomised Double-blind Clinical Study

Introduction: General anaesthesia is commonly facilitated by endotracheal intubation, for which Neuromuscular Blocking Agents (NMBA) are used to achieve optimal intubating conditions and haemodynamic stability. Atracurium and cisatracurium are benzylisoquinolinium neuromuscular blockers with distinct pharmacokinetic and pharmacodynamic profiles, which may influence intubation quality and cardiovascular responses. Aim: To compare Cisatracurium and Atracurium in patients requiring general anaesthesia and undergoing elective surgery with respect to intubating conditions and haemodynamic responses during laryngoscopy. Materials and Methods: This randomised double-blinded clinical study was conducted at the Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India, from August 2023 to September 2024. A total of 74 American Society of Anaesthesiologists (ASA) physical status grade I-II patients scheduled for elective surgery under General Anaesthesia (GA) were enrolled and randomly assigned to two equal groups of 37 each. Participants in Group A received Atracurium 0.5 mg/kg intravenously, while those in Group C received Cisatracurium 0.2 mg/kg intravenously. Intubation conditions, cardiovascular stability, duration of action, and cost parameters were evaluated for both groups. Continuous variables were expressed as mean±SD and compared using an Independent t-tests or Mann-Whitney U test, while categorical variables were analysed using Chi-square or Fisher’s-exact tests. Results: The mean age of participants was 37.9 years, with group A averaging 37.9±10.9 years and group C averaging 38.0±12.2 years. Diastolic Blood Pressure (DBP) differed significantly between groups immediately after induction (70.51±14.49) and at 2 (69.68±16.53), 4 (82.00±17.41), and 6 (79.86±10.56) minutes (p<0.001). Mean Arterial Pressure (MAP) also showed significant variation at 2 minutes (70.32±8.07) and 4 minutes (83.86±16.61) (p-value <0.001), whereas Heart Rate (HR) and Oxygen Saturation (SpO2) remained comparable. Maintenance dose duration was shorter in Group A (38.3±7.5 min) than in Group C (64.9±20.8 min; p<0.001). Conclusion: Cisatracurium and atracurium are intermediateacting muscle relaxants; however, cisatracurium releases less histamine, ensuring steadier haemodynamics. The present study inferred that cisatracurium offers favourable haemodynamics, superior intubating conditions, and longer duration of action, although it may be slightly expensive, suggesting that cisatracurium may offer clinical advantages in selected settings.