Effects of Hydrocortisone on Hemodynamic Changes by Atracurium for Intubation in Patients Under General Anesthesia: A Randomized Controlled Trial

Atracurium, as one of the neuromuscular relaxants, is one of the most important irritants of the allergic reaction during anesthesia, which causes the release of histamine. This study was conducted with the aim of determining the effect of hydrocortisone on hemodynamic changes resulting from atracurium drug in patients with upper limb fractures under general anesthesia.

In this double-blind randomized clinical trial study, 50 patients with upper limb fractures under general anesthesia, 18 to 60 years old with ASA class 1 and 2, were randomly assigned to two groups of hydrocortisone and placebo (distilled water). In intervention group, 30 minutes before entering the operating room, vial oxycort (hydrocortisone) was administered intravenously and bolus with 300 ml of normal saline. Hemodynamic changes in patients before administration of hydrocortisone, 30 minute after administration, 5 minutes after the peak effect of atracurium (before intubation) and after extubation were recorded in the relevant checklist and comparisons were made between the two groups.

There was no significant difference between the two groups in terms of age, gender and duration of surgery. Systolic blood pressure 5 minutes after the peak effect of atracurium (before intubation) in the control group was lower than the intervention group and this difference was statistically significant (P=0.02). Thirteen minute after hydrocortisone administration, mean blood pressure systolic and diastolic patients decreased and this decrease continued after administration of histamine release atracurium (before intubation); but after extubation, the patients’ mean blood pressure has increased. Also, after administration of atracurium, the mean heart rate of patients decreased by 14.44 units as compared to before administration of hydrocortisone and this decrease was significant (P=0.001).

The results of this study show that hydrocortisone can be used as an effective factor in maintaining hemodynamic stability in patients under general anesthesia. However, its use as a factor in maintaining hemodynamics has not yet been widespread and needs further investigation.