Randomized prospective study to compare intubating conditions with cisatracurium or rocuronium using train-of-four neuromuscular monitoring in adult patients undergoing elective surgery

Background: Nondepolarizing skeletal muscle relaxants are used in anesthesia to ease endotracheal intubation and improve ventilation. Monitoring neuromuscular blockade is crucial to minimize residual paralysis and optimize dosing. Aims and Objectives: Our study compared the intubating score, intraoperative hemodynamic changes, and clinical duration of loading dose with cisatracurium and rocuronium using train-of-four (TOF) neuromuscular monitoring during elective surgeries. Materials and Methods: This prospective, randomized controlled trial included 80 patients undergoing planned laparoscopic abdominal surgeries. Patients were randomized into two groups of 40 each, receiving either cisatracurium (Group A) or rocuronium (Group B). Neuromuscular blockade was monitored using TOF at the adductor pollicis longus, and intubating conditions were assessed based on jaw relaxation, Cormack–Lehane grading, vocal cord status, limb movement, and intubating score. Results: There were no statistically significant demographic differences between the groups. Rocuronium achieved a significantly shorter mean onset time for tracheal intubation (156.00±12.41 s) compared to cisatracurium (179.43±13.08 s, P<0.0001). Jaw relaxation was better in the rocuronium group (100% vs. 87.5%, P=0.0209). The mean clinical duration of loading dose in group A (38.625 min) and group B (38min; P=0.4561). Intubation conditions were rated as excellent in 80% of the rocuronium group versus 40% in the cisatracurium group (P=0.0003). Hemodynamic parameters remained stable across both groups. Conclusion: Rocuronium demonstrated superior intubating conditions and a faster onset compared to cisatracurium, making it a more effective neuromuscular blockade agent for rapid intubation in elective surgeries, whereas cisatracurium was more economical.