What are the differences between vecuronium and cisatracurium and which is preferred for neuromuscular blockade in hypothermia after cardiac arrest?

摘要

TTM is intended to limit neurologic injury postcardiac arrest. This benefit is provided through reduction in metabolic demand, attenuation of oxidative stress, and inhibition of apoptosis (Holzer, 2010). Induction of hypothermia and subsequent attainment of target temperature may, however, be delayed by shivering. Shivering is a physiologic response which attempts to maintain core body temperature (Weant et al., 2010, Lascarrou et ah, 2014). During TTM shivering is counterproductive as it increases metabolic rate, causes release of inflammatory mediators, and generates heat (Riker et al., 2015). Numerous pharmacologic agents (e.g., meper-idine, dexmedetomidine, magnesium, propofol, and so on) have been investigated to reduce shivering response (Weant et al, 2010). Of the pharmacologic agents utilized to mitigate shivering, neuromuscular blocking agents (NMBAs) are among the most widely used. A recent study by Pearson et al. (2017) found that early NMBA administration was associated with improved time to target temperature attainment. Despite this proposed benefit and widespread use, the optimal NMBA to control shivering during TTM is not well defined.