Duration of Vecuronium-Induced Neuromuscular Block as a Predictor of Liver Allograft Dysfunction
| Autor: | T C Gunning, Cara L. Lukin, Thomas H. Swygert, Ross B. Nelson, Steven K. Donica, H. A. Tillmann Hein, T. R. Valek, Michael A. E. Ramsay |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Graft Rejection Male Time Factors Orthotopic liver transplantation Group ii Sensitivity and Specificity Coagulopathy Humans Medicine Aspartate Aminotransferases Alanine aminotransferase Aged Prothrombin time Vecuronium Bromide medicine.diagnostic_test business.industry Alanine Transaminase Nerve Block Metabolic acidosis Middle Aged medicine.disease Liver Transplantation Transplantation Anesthesiology and Pain Medicine Liver Anesthesia Reperfusion Female Liver function business |
| Zdroj: | Anesthesia & Analgesia. 80:526-533 |
| ISSN: | 0003-2999 |
| DOI: | 10.1097/00000539-199503000-00016 |
| Popis: | The major causes of liver graft failure are acute rejection, technical failure, and primary nonfunction (PNF). This study was undertaken to determine whether delayed return of neuromuscular function correlates with allograft primary dysfunction in humans given vecuronium. Twenty-two adult patients undergoing orthotopic liver transplantation were given an initial dose of vecuronium, 0.1 mg/kg intravenously (IV). All patients recovered from vecuronium-induced neuromuscular block prior to explantation. No additional neuromuscular blocker was given until the liver graft was implanted and reperfused. Fifteen minutes after reperfusion another 0.1 mg/kg vecuronium was given IV and recovery time from attaining complete neuromuscular block to return of the fourth twitch of a train-of-four was recorded. Patients were divided into three groups according to postoperative liver function. Group I consisted of 17 patients with immediate normal liver graft function. Group II consisted of four patients with primary dysfunction (PDF) [peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) >2000 U/L, prothrombin time >16 s, and poor quality and quantity of bile within 3 days postoperatively] which eventually recovered normal function. Group III consisted of one patient with PNF (uncorrectable coagulopathy, severe metabolic acidosis, rising AST and ALT, and minimal or no bile output), whose graft never recovered. Recovery time in Groups II and III was prolonged compared to Group I (P 135 min as a predictor of PDF has a sensitivity and specificity of 80% and 76%, respectively. The positive and negative predictive values are 50% and 93%. Duration of neuromuscular block after vecuronium administration appears to be an early predictor of liver allograft function |
| Databáze: | OpenAIRE |
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