ANAESTHESIA

1. Cis atyracurium is prefferd over atracurium due to advantage of a. Rapid onset b. Short duration of action c. No histamine release d. Less cardiode Ans. No histamine release Difference between cisatracurium and atracurium Cisatracurium is a stereoisomer of atracurium Metabolism of both atracurium and cisatracurium produce laudanosine as metabolite but cistracurium produces very less amount metabolite Atracurium is also metabolized by alternative pathway by nospecific esterase Histamine release is very less by cistracurium Cisatracurium It is a neuromuscular blocking drug or skeletal muscle relaxant in the category of nondepolarizing neuromuscular-blocking drugs. Used adjunctively in anesthesia to facilities endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation It is a bisbenzyltetrahydoisoquinolinium agent with an intermediate duration of action. Cisatracurium is one of the ten isomers of the parent molecule, atracurium Moreover, cisatracurium represent -15% of the atracurium mixture Pharmacology As is evident with the parent molecule, atracurium-cistracurium is also susceptible to degradation by Hofmann elimination and ester hydrolysis as components of the in vivo metabolic processes Because Hofmann elimination is a temperature-and plasma pH-dependent process, cisatracuriums rate degradation in vivo is highly influenced by body pH and temperature just as it is with the prevent molecule, atracurium: thus, an increase in body pH favors the elimination process, whereas a decrease in temperature slow down the process One of the metabolites of cistracurium via Hofmann elimination is laudanosineQ 80% of cisatracurium is metabolized eventually to laudanosine and 20% is metabolized hepatically or excreted renally. 10-15% of the dose is excreted unchanged in the urine Since hofmann elimination is an organ-independent chemodegradative mechanism, there is little or no risk to the use of cisatracurium in patients with liver or renal disease when compared with other neuromuscular blocking agents Adverse effects Histamine release-hypotension, reflex tachycardia and cutaneous flush o Unlike the parent, atracurium, cisatracurium affords a much better pharmacological profile with respect to eliciting Bronchospasm Pulmonary compliance To date, cistracurium has not been reported to elicit bronochospams at doses that are clinically presecribed Laudanosine-Epileptic foci i. Cisatracurium undergoes Hofamnn elimination as a primary route of chemodegradation: consequently one of the metabolites from this process is laudanosine, a tertiary amino alkaloid reported to be a modest CNS stimulant

with epileptogenic activity and cardiovascular effects such a hypotension and bradycardia ii. As a ertiary amine, Laudanosine is unionized and readily crosses the blood-brain berrier iii. Presently, there is little evidence that laudanosine accumulation and related toxicity will likely over be seen with the doses of cisatracurium that are administered in clinical practive especially given that the plasma concentrations of laudanosine generated are lower with cistracurium than those seen with atracurium 2. Laudanosine is metabolite of a. Cis atracurium b. Atracurium c. Pancuronium d. Gallamine Ans. B Atracurium Metabolism of birth atracurium and cistracurium produces laudanosine as metabolic but cistracurium produces very less amount metabolic Laudanosine-Epileptic foci Because atracurium undergoes Hofmannn elimination as a primary route of chemodegradation, not surprisingly one of the major metabolites from this process is laudanosis, a tertiary amino alkaloid reported to be a modest CNS stimulant with epileptogenic activity and cardiovascular effects such a hypotension and bradycardia The purported hypothesis being that the laudanosine produced from the chemodergradation of parent atracurium would cross the blood-brain barrier in sufficiently high concentrations that lead to epileptogenic foci Laudanosine is also a metabolite of cisatracurium which, because of its identical structure to atracurium, undergoes chemodegradation via Hofmann elimination in vivo Plasma concentrations of laudanosine generated are lower when cisatracurium is used