Abstract

Background: The aim of the study is, to compare intermittent bolus versus continuous infusion of cisatracurium in neurosurgical procedures.
Materials and Methods: A prospective, randomized, single blind control study was conducted on 32 adult patients undergoing craniotomy under general anesthesia at King George Hospital, Visakhapatnam during the period   from August 2019-August 2021, after obtaining the approval from Institutional Ethical Committee (Andhra Medical College) and written informed consent from the patients who participated in this study. In this study 32 adult patients aged between 18 – 65 years, belonging to ASA grade I and II, undergoing craniotomy under general anesthesia were randomly assigned into two equal Intermittent Bolus and Continuous Infusion groups, to assess the intraoperative hemodynamics, cost effectiveness, muscle relaxation and postoperative recovery characteristics of the two technique of administering muscle relaxants during intraoperative period.
Results: The mean age, mean duration of surgery, and gender distribution was statistically similar in both groups. The mean pulse rate , SBP,DBP in group IN was significantly lower 10 min after starting infusion, 2 minutes after stopping infusion and 10 minutes after stopping  infusion of cisatracurium (p<0.05] compared with intermittent bolus group.   There was no statistical significant difference in weight of the patients between the two groups. Initial bolus dose requirements in group IN are 8.51±1.08mg and group IB is 8.58±1.06mg, which is statistically insignificant. There was statistical difference in maintenance dose requirement between two groups. Mean dose required for intermittent bolus is statistically lower than the infusion (P=0.0001).  TIME in min to achieve ideal intubating conditions after initial bolus dose that is TOF 0 among two groups was statistically similar. Time in min for return of TOF 1 after initial bolus dose is statistically similar in both groups.  Time to reach steady plasma state that is TOF 0 among two groups was statistically significant that is infusion group achieves steady state faster than intermittent bolus group with p value of 0.0001.  There was no statistical significance in recovery between two groups after stopping infusion and last dose of intermittent bolus.
Conclusion: Cisatracurium infusion had greater hemodynamic stability than intermittent bolus administration. However totals drug consumption was significantly lower in intermittent bolus method of administration than infusion.