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VOLUME 7 , ISSUE 1 ( January-June, 2018 ) > List of Articles

Original Article

Prospective Comparative Randomized Controlled Study to Determine the Optimal Priming Dose of Atracurium

Arun Kumar Handigodu Duggappa, Shaji Mathew, Abhishek Rao Kordcal, Arun Chakravarthi, Shiyad Muhamed

Keywords : Atracurium, neuromuscular relaxants, priming, train-of-four

Citation Information : Duggappa AK, Mathew S, Kordcal AR, Chakravarthi A, Muhamed S. Prospective Comparative Randomized Controlled Study to Determine the Optimal Priming Dose of Atracurium. Indian J Respir Care 2018; 7 (1):42-45.

DOI: 10.4103/ijrc.ijrc_26_17

License: CC BY-NC-SA 3.0

Published Online: 02-12-2022

Copyright Statement:  Copyright © 2018; Indian Journal of Respiratory Care.


Abstract

Introduction: The advantages of the use of muscle relaxants in the current practice of balanced anesthesia are well documented. Most often, nondepolarizing muscle relaxants (NDMR) with minimal side effects are used to serve the purpose. Atracurium is a commonly used NDMR in day-to-day anesthetic practice, although it is not desirable for rapid sequence induction and intubation due to its late onset of action. To overcome this problem priming principle was introduced. Aim: This study aims to determine optimal priming dose of atracurium to speed up the onset of action. Patients and Methods: In this prospective randomized controlled study, 90 patients were allocated into one of the three groups by a computer-generated table of random numbers, i.e., Group A, B, and C. Total dose of atracurium used in all patients was 0.5 mg/kg body weight, including the priming dose. Each group received different priming doses of atracurium as follows: Group A received 0.05 mg/kg body weight, Group B received 0.025 mg/kg body weight, whereas Group C (control) received saline as priming dose. Results: Patients were comparable with respect to demographic data. The mean duration in seconds for train-of-four (TOF) count to reach zero were 147 s, 193, and 218 s in Group A, B, and C, respectively, with statistically significant P values. Of 60 patients who were administered atracurium as priming drug, two patient had ptosis at the end of 3 min after priming with 0.05 mg/kg body weight, with no other side effects. Conclusions: Priming principle employing atracurium reduces the time required for TOF count to reach zero by approximately 71 s while using 0.05 mg/kg body weight and by around 25 s while employing 0.025 mg/kg body weight, with clinically insignificant incidence of adverse effects.


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  1. Stenlake JB, Waigh RD, Urwin J, Dewar GH, Coker GG. Atracurium: Conception and inception. Br J Anaesth 1983;55 Suppl 1:3S-10S.
  2. Stenlake JB, Waigh RD, Dewar GH. Biodegradable neuromuscular blocking agents. Atracurium besylate and related polyalkylene di-esters. Eur J Med Chem 1981;16:515-24.
  3. Schwarz S, Ilias W, Lackner F, Mayrhofer O, Foldes FF. Rapid tracheal intubation with vecuronium: The priming principle. Anesthesiology 1985;62:388-91.
  4. Mehta MP, Choi W, Gergis SD, Sokoll MD, Adolphson A. Facilitation of rapid sequence endotracheal intubations with divided doses of nondepolarizing neuromuscular blocking drugs. Anesthesiology 1985;62:392-5.
  5. Naguib M, Lien CA. Pharmacology of muscle relaxants and their antagonists. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 859-911.
  6. Stiller RL, Cook DR, Chakravorti S. In vitro degradation of atracurium in human plasma. Br J Anaesth 1985;57:1085-8.
  7. Miller RD, Rupp SM, Fisher DM, Cronnelly R, Fahey MR, Sohn YJ, et al. Clinical pharmacology of vecuronium and atracurium. Anesthesiology 1984;61:444-53.
  8. Stoelting RK, Hillier SC. Neuromuscular blocking drugs. In: Stoelting RK, Hiller SC, editors. Pharmacology and Physiology in Anesthetic Practice. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 208-50.
  9. Mirakhur RK, Lavery GG, Clarke RS, Gibson FM, McAteer E. Atracurium in clinical anaesthesia: Effect of dosage on onset, duration and conditions for tracheal intubation. Anaesthesia 1985;40:801-5.
  10. Engbaek J, Howardy-Hansen P, Ording H, Viby-Mogensen J. Precurarization with vecuronium and pancuronium in awake, healthy volunteers: The influence on neuromuscular transmission and pulmonary function. Acta Anaesthesiol Scand 1985;29:117-20.
  11. Naguib M, Abdullatif M, Absood GH. The optimal priming dose for atracurium. Can Anaesth Soc J 1986;33:453-7.
  12. Naguib M, Gyasi HK, Abdulatif M, Absood GH. Rapid tracheal intubation with atracurium – A comparison of priming intervals. Can Anaesth Soc J 1986;33:150-6.
  13. Mishra LD, Nath SS, Bhattacharya DP. Effect of priming on intubating conditions produced by atracurium. Indian J Anaesth 2003;47:458-62.
  14. Jaradi H, Tay KH, Delilkan AE. Shortening the onset time of atracurium for rapid tracheal intubation. Med J Malaysia 1989;44:143-6.
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