Department of Anesthesiology and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Iran.
Eur Rev Med Pharmacol Sci. 2013 Feb;17(4):447-50.
Non-depolarizing neuromuscular blocking agents (NMB) differ in pharmacokinetic and pharmacodynamic parameters. An anesthesiologist according to these similarities and differences is able to choose the least costly one if the same safety profile and same clinical benefit achieved with the different alternatives.
The main objective of this study is to evaluate the economic and adverse drug reactions prevalence and differences between cisatracurium and atracurium the two non-depolarizing NMB drugs, which are widely used in adult patients undergoing surgery with general anesthesia in a teaching Hospital in Iran.
A cost analysis and adverse drug reactions (ADR) monitoring were performed. Only direct costs were considered and data were collected through a prospective randomized study. Regardless of the type of surgery, 100 patients were randomly divided into two equal groups to receive either cisatracurium or atracurium by anesthesiologists. ADRs prevalence and cost differences between patients receiving one of the two non-depolarizing NMB agents were evaluated by independent sample t-test and Chi-square test respectively.
No significant difference was observed between the two groups of patients in demographic data. There was no statistical difference in the ADR prevalence in both groups. The numbers of ADR within atracurium group was higher than cisatracurium group, but this distinction was not statistically significant (p > 0.05). It was significant difference in cost between the two neuromuscular blocking drugs (p < 0.05).
According to our study it seems that atracurium and cisatracurium had similar safety profile and atracurium had a cost benefit relative to cisatracurium in initial loading doses. In patients with instability in hemodynamic parameters the cisatracurium was the appropriate choice.
非去极化神经肌肉阻滞剂（NMB）在药代动力学和药效动力学参数方面存在差异。麻醉师可以根据这些相似性和差异，选择成本最低的药物，如果不同选择具有相同的安全性和相同的临床获益。
本研究的主要目的是评估两种非去极化 NMB 药物——顺式阿曲库铵和阿曲库铵——在伊朗一所教学医院接受全身麻醉手术的成年患者中的经济成本和不良反应（ADR）发生率及差异。
进行了成本分析和药物不良反应（ADR）监测。仅考虑直接成本，并通过前瞻性随机研究收集数据。无论手术类型如何，将 100 名患者随机分为两组，分别接受顺式阿曲库铵或阿曲库铵。通过独立样本 t 检验和卡方检验分别评估接受两种非去极化 NMB 药物之一的患者之间 ADR 发生率和成本差异。
两组患者的人口统计学数据无显著差异。两组患者的 ADR 发生率无统计学差异。阿曲库铵组的 ADR 数量高于顺式阿曲库铵组，但差异无统计学意义（p>0.05）。两种神经肌肉阻滞剂的成本存在显著差异（p<0.05）。
根据我们的研究，阿曲库铵和顺式阿曲库铵似乎具有相似的安全性，阿曲库铵在初始负荷剂量方面相对于顺式阿曲库铵具有成本效益。在血流动力学参数不稳定的患者中，顺式阿曲库铵是合适的选择。
