A comparative study of intubating conditions with two different doses of cisatracurium besylate in patients undergoing general anaesthesia

General anesthesia is essential for facilitating surgeries by ensuring patient unconsciousness, analgesia, and often muscle relaxation. Endotracheal intubation is an essential component of general anesthesia, providing a secure airway and enabling controlled ventilation during surgery. Optimal intubating conditions are crucial for minimizing airway trauma, hemodynamic disturbances, and patient discomfort. Muscle relaxants play a vital role in achieving these conditions.

Succinylcholine, a depolarizing neuromuscular blocker, has traditionally been the drug of choice due to its rapid onset and short duration. However, its significant side effects—including hyperkalemia, malignant hyperthermia, increased intraocular pressure, and bradyarrhythmias—limit its use in certain patient populations. This has led to a shift toward safer non-depolarizing agents like atracurium and cisatracurium besylate.

Although atracurium is effective, its potential to cause histamine release—resulting in adverse effects such as hypotension, tachycardia, and bronchospasm—has the need for safer alternatives like cisatracurium in clinical practice.

Cisatracurium is a stereoisomer of atracurium, known for its intermediate duration of action, minimal histamine release, and organ-independent metabolism via Hofmann elimination. It is 3–4 times more potent than atracurium and demonstrates a favorable hemodynamic profile, even at higher doses. These properties make it suitable for use in patients with hepatic or renal dysfunction. The ideal dose of cisatracurium for intubation remains under evaluation, balancing between achieving optimal intubating conditions and minimizing residual neuromuscular blockade.

While the standard intubating dose is generally considered to be 2×ED95 (0.1 mg/kg), higher doses such as 0.15 mg/kg and 0.2 mg/kg have been suggested to improve intubation conditions without significantly prolonging recovery. However, comparative data between these two dosing strategies is limited.

This study is designed to evaluate and compare the intubating conditions, hemodynamic responses, and potential adverse effects of two different doses of cisatracurium besylate—0.15 mg/kg and 0.2 mg/kg—in patients undergoing general anesthesia. The results will help optimize dosing strategies for improved patient outcomes and safer anesthetic practice.