Study Of Consumption Of Cisatracurium Using A Closed Loop Computer Control Infusion

Objective:The objective in this study was to analyze the variations in consumption of cisatracurium in a wide group of patients under different kind of general anesthesia. For better understanding how the consumption of cisatracurium changes in different scenarios, we devised three separate clinical studies where we also observed the recovery period and consumption of sufentanil and propofol. The closed loop computer control infusion system of cisatracurium allowed us not only to adjust a constant level of muscle relaxation but also provided accurate measurements of cisatracurium consumption. This allowed us to better appreciate the effect of other anesthetic drugs on cisatracurium consumption, thus allowing anesthesiologists to understand how to adjust drug dosage and hence minimizing side effects.Method:The first clinical study was entitled’Analysis of Cisatracurium and Sufentanil Consumption in Balanced Anaesthesia With1%Sevoflurane, and With Only Sevoflurane, Using a Closed-loop Computer Controlled System Infusion’. It quantified the change in consumption of cisatracurium and sufentanil with1%sevoflurane and in totally inhalated sevoflurane anesthesia. Maintenance of general anesthesia can be conducted as total intravenous anesthesia, or inhalated anesthesia, or a combination of both that is balances anesthesia. In this study we analyzed the effect of sevoflurane on cisatracurium consumption in all three different scenarios.The second study was’Effect of Dexmedetomidine on Cisatracurium and Sufentanil consumption, using a closed loop computer control system’. Dexmedetomidine is an innovative drug which is increasingly being used in intensive care units and intra-operatively as an adjuvant drug due to its analgesic and sedative effects. Since scarce studies have worked on the effect of dexmedetomidine on muscle relaxants, we devised this study to accurately quantify how cisatracurium infusion requirement changes when dexmedetomidine is added intra-operatively. We extended our observation on the recovery period, consumption of propofol and sufentanil.Our third study entitled,’Study of consumption of Cisatracurium, Sufentanil and Propofol in different age groups, using a closed loop computer controlled system’ demonstrates the age factor influence on the three named drugs and recovery period. Minimizing dosage of anesthetic drugs promotes better recovery from general anesthesia especially in the elderly population. To interpret how consumption of the anesthetic drugs changes with age more than two groups are required. In this study we grouped the patients in three different age groups and observed the consumption of cisatracurium, sufentanil and propofol in each. We further evaluated the change in recovery period with age.Results:Combining the results of our studies we found that a dose of1%sevoflurane (0.4MAC) in balanced anaesthesia was enough to cause a significant difference in cisatracurium consumption but did not contribute significantly to the effect of analgesic medicine. It is thus recommended to decrease dose of cisatracurium by approximately12%when1%sevoflurane is added during general anaesthesia or29.5%if a TIVA general anaesthesia is converted to totally inhalated. Secondly, we would also conclude that dexmedetomidine, in addition to its anesthetic-sparing effects by decreasing the consumption of cisatracurium infusion and sufentanil by16.4%and17.9%respectively, it also offered a special type of sedation in which patients were readily arousable with preservation of the respiratory function without significant delay of the recovery index. And finally, we would state that the sensitivity of anesthetic agents increases with age. Less medication was required to achieve a desirable pharmacological effect in older patients, and the drug effect was prolonged among patients above65years of age. Older patients would need a downward adjustment in medication dose for the same pharmacological effect.Conclusion:Understanding the change in consumption of different anesthetic drugs and muscle relaxants in different situations allows anesthesiologists to better estimate drug dosage in their daily practice. Adjustment of cisatracurium infusion is required when sevoflurane or dexmedetomidine is added intra-operatively, as well as when patients are above65years of age.