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KMID : 0869620210380040439
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Journal of Korean Society of Hospital Pharmacists
2021 Volume.38 No. 4 p.439 ~ p.449
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Effectiveness and Safety of Cisatracurium Versus Vecuronium During Targeted Temperature Management in the Neurocritical Care Patients
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Kim So-Hee
Song Young-Joo
Jeong Young-Mi
Choi Kyung-Suk
Lee Eun-Sook
Lee Euni
Han Moon-Ku
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Abstract
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Background : Neuromuscular blocking agents are used as the last step for preventing shivering during targeted temperature management (TTM). Cisatracurium has a shorter half-life than vecuronium and does not affect the liver and renal function. The objective of this study was to compare the effectiveness and safety between two neuromuscular blockers in order to determine the benefit of cisatracurium during TTM.
Methods : We reviewed electronic medical records of patients in the neurocritical care unit (NCU) who received cisatracurium or vecuronium during TTM at Seoul National University Bundang Hospital from February 2011 to May 2018. The incidence of shivering and the recovery time of motor function were evaluated as effectiveness parameters. The incidence of bradycardia, hypotension duration of antibiotic use, and mortality rate after discontinuation of the neuromuscular blocker were evaluated as safety parameters. Recovery time of motor function was assessed by using motor power and Glasgow Coma Scale (GCS).
Results : A total of 53 patients were included in the cisatracurium group and 50 patients in the vecuronium group. The incidence of shivering was 18.0% and 18.9% (p=0.910) in the vecuronium and cisatracurium groups, respectively.The median recovery time of motor function was 7.0 hours [3.7-20.3 hours] and 1.7 hours [1.0-3.3 hours] (p<0.001) based on the Motor Power score, and the median recovery time of motor function was 6.5 hours [3.7-23.5 hours] and 1.7 hours [1.0-3.3 hours] (p<0.001) based on the motor response score of GCS, respectively.
Conclusion : Recovery time of motor function was significantly shorter in the cisatracurium group than in the vecuronium group and there was no significant difference in safety outcomes. This study identified the benefits of cisatracurium in the NCU under TTM.
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KEYWORD
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Targeted temperature management, Cisatracurium, Vecuronium, Neurocritical care, Shivering control
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