RocCisRecoveryStudy

Background and aim: Neuromuscular monitoring has decreased the incidence of post-operative residual curarization. The rationale of this study was to assess the incidence of this complication, and to compare recovery characteristics in intermediate acting neuromuscular blockers (NMB) rocuronium and cisatracurium. Study Design: We designed an observational study including 100 participants, aged 18 - 80 years, of American Society of Anesthesiology Physical Status (ASA-PS) 1 and 2, undergoing elective surgery under general anesthesia requiring endotracheal intubation. The design is an observational study, and was conducted in KMC Hospitals, Mangalore, after the approval from Institutional Ethics Committee, from August 2018 till June 2020. The study population were adult patients admitted for surgeries under general anesthesia. Sample size: n = 100, by n = 2(Zα +Zβ)2 x σ2 / d2 where, Zα = 1.96 at 95% confidence level and Zβ = 1.28 at 95% power. With 95% CL and 95% power shown with reference to SBP, sample size came to 100, ie. 50 x 2 = 100. The patients were divided into 2 groups: • Group ROC were administered Inj rocuronium1.2mg/kg, • Group CIS were given Inj cisatracurium 0.2mg/kg for intubation. The sample method was convenience sampling. On arrival of the patient to the post-anesthesia care unit (PACU), we assessed for clinical recovery in terms of the following outcome variables - hand grip and sustained head lift each > 5 seconds and qualitative assessment in terms of double burst stimulation (DBS3,3) at 10,15, 30 & 60 minutes after extubation. Numerical data were expressed as a mean ± standard deviation and analyzed using the Student’s t‑test and Anova p test. P value<0.05 was considered significant. Results: Twitch response to DBS on arrival to PACU after 15 min was 21% out of which rocuronium group had 13 (26%) patients and cisatracurium had 8 (16%) patients. The differences in both the groups were statistically insignificant (p= 0.220). In terms of hand grip, a total of 11% patients had recovered at 15 min after arrival to PACU. Rocuronium group had 8(16%) patients and cisatracurium had 3(6%) patients (p = 0.110). Sustained head lift > 5 sec showed 12% patients recovered at 15 min on arrival to PACU, in which rocuronium group had 7(14 %) and cisatracurium group had 5 (10%)patients with a p value 0.538. The statistical data were analyzed using SPSS 17. The qualitative data were perused with student unpaired ‘t’ test, chi square test. A p-value < 0.05 was taken to be statistically significant. Proforma was used to collect the data for analysis. Conclusion: Use of DBS and clinical parameters in the PACU, could aid in identifying patients with residual neuromuscular blockade in both the group of drugs.There is no significant difference in the recovery status between the rocuroniumand cisatracurium groups, although incidence of residual paralysis was noted in both the groups using neuromuscular monitoring.