Asian Journal of Pharmacy, Nursing and Medical Sciences (ISSN: 2321 – 3639) Volume 02 – Issue 06, December 2014 Asian Online Journals (www.ajouronline.com ) 110 Comparison of Modified and High Dose of Cisatracurium for Rapid Sequence Intubation Houman Teymourian * , Mohamad Amin Samet, Seyed Amir Mohajerani, Alireza Jafari Department of Anesthesiology, Shahid Beheshti University of Medical Sciences Tehran, Iran Corresponding author’s email: houman72625 {at} yahoo.com _________________________________________________________________________________________________ ABSTRACT--- Introduction: Rapid Sequence induction is a safe method of endotracheal intubation in emergency settings. Succinylcholine rapid onset of effect and ultrashort duration of action permitted rapid endotracheal intubation. To avoid Succinylcholine adverse effects, Cisatracurium at high dose is candidate. Aim: to compare rapid sequence intubation conditions using modified and high dose of cisatracurium. Methods: In a randomized, double-blind clinical trial 300 patients were enrolled in the study and randomly assigned to receive modified dose (0.3 mg/kg) Cisatracurium or high dose (0.4 mg/kg) Cisatracurium for intubation. Primary outcome was larygoscopy and intubation conditions including vocal cords movement and position and secondary outcome was hemodynamics during and after intubation. All data and train of four (TOF) were recorded at 0 to 5 min after drug administration. Intubation was performed at 90 min after drug administration when TOF=0. Results: 300 patients were divided into 2 groups of 0.3 mg/kg and 0.4 mg/kg. Age, sex and weight were not significantly different between two groups of study. The onset time of complete neuromuscular blockade (TOF=0) were not significantly different between modified dose (85±22 seconds) and high dose (86±26 seconds) of Cisatracurium. Vocal cords movements were observed in 3 patients in modified dose group and 2 patients in high dose group which was not significantly different (p=0.082). Blood pressure and heart rate were not significantly different between two groups of study at any time points (p>0.05). Conclusion: 0.3 versus 0.4 mg/kg cisatracurium had the same effect in providing appropriate laryngoscopy condition for rapid sequence intubation after 90 seconds. it is safer to use modified 0.3 mg/kg instead of 0.4 mg/kg cisatracurium to achieve acceptable condition for rapid sequence intubation. Keywords---- Cisatracurium, Rapid sequence intubation, hemodynamic ____________________________________________________________________________________________ 1. INTRODUCTION Rapid Sequence induction is a safe method of endotracheal intubation that is performed in emergency settings and full stomach patients because it provides muscle relaxation within 60 to 90 seconds. Succinylcholine, introduced by Thesleff 1 and Foldes and colleagues 2 in 1952, changed anesthetic practice drastically. Its rapid onset of effect and ultrashort duration of action permitted rapid endotracheal intubation. Administration of succinylcholine to an otherwise well individual for an elective surgical procedure increases plasma potassium levels by approximately 0.5 mEq/dL. This increase in potassium is due to the depolarizing action of the Succinylcholine. Several early reports suggested that patients in renal failure may be susceptible to a hyperkalemic response to succinylcholine 3,4 . Sinus bradycardia is particularly problematic in individuals with predominantly vagal tone, such as children who have not received atropine. Besides, Succinylcholine usually causes an increase in intraocular pressure (IOP). When succinylcholine is considered undesirable or contraindicated, the onset of action of nondepolarizing neuromuscular blocking drugs can be accelerated by larger doses of neuromuscular blockers 5 . To replace Succinylcholine intermediate drugs such as Cisatracurium are candidates, but it is a nondepolarizing muscle relaxant with a slow onset. ED95 os Cisatracurium is 0.05 mg/kg. Traditionally, Cisatracurium doses used to facilitate tracheal intubation are 2×ED95 (0.01 mg/kg), and the high dose for rapid intubating (8×ED95) is 0.4 mg/kg.