Comparison of Modified and High Dose of Cisatracurium for Rapid Sequence Intubation

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.