A comparative study of efficacy of atracurium and cisatracurium for hemodynamic stability in patients undergoing laparoscopic surgeries

Laparoscopic surgeries are done very commonly nowadays in every part of the world. They have many advantages compared to open procedures like less surgical trauma, less intraoperative and postoperative pain which would result in early ambulation and discharge, thus reducing duration and cost of hospital stay.However, Surgical stress responses during laparoscopic surgeries may be as strong as in open surgeries due to creation of pneumoperitoneum by carbon dioxide.It may lead to alteration in acid base balance, cardiovascular and pulmonary physiology. The introduction of nondepolarizing neuromuscular blocking agents has helped overcome most of these adverse effects making the administration of neuromuscular blockade comparatively safer. Neuromuscular blocking drugs interrupt transmission of nerve impulses at neuromuscular junction thus aid endotracheal intubation, mechanical ventilation, decrease anaesthetic requirement, prevent patient movement, facilitate surgery and decrease oxygen consumption by reducing the work of breathing.(4,5) Vecuronium and Atracurium are commonly used NMBAs in General Anaesthesia.Atracurium is preferred in patients with renal failure and does not affect intracranial or intraocular pressure. However, it has the potential to cause histamine release. Cisatracurium, a purified stereoisomer of atracurium, is similar to it in almost all aspects but is not associated with histamine release in humans. So it can be helpful in maintaining hemodynamic stability.  So we decided to compare hemodynamic characteristics of atracurium and cisatracurium. Apart from neuromuscular blockers, other medications like alpha2 agonists- Dexmeditomidine,  nitroglycerine  a venodilator, beta blockers and opioids are used to provide hemodynamic stability during pneumoperitoneum created for laparoscopic surgeries.  There are some previous studies which have compared Atracurium and Cisatrcurium for maintaining hemodynamic stability in general anaesthesia other than laparoscopic surgeries. Our primary outcome is to compare hemodynamic characteristics and secondary outcome is to observe requirement of vasoactive agents (vasopressors and vasodilators) in intraoperative period, complications like erythema, hypotension, bronchospasm between the two groups.