Dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation
| Autor: | Guy Cammu, Luc De Baerdemaeker, Michel Struys, Nadia Den Blauwen, Gudrun Bossuyt, Eric Mortier |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Adolescent medicine.medical_treatment Neuromuscular Junction Neuromuscular transmission Liver transplantation Synaptic Transmission Laudanosine chemistry.chemical_compound Liver disease Pharmacokinetics medicine Humans Aged Electromyography business.industry Middle Aged medicine.disease Liver Transplantation Transplantation Anesthesiology and Pain Medicine chemistry Cisatracurium besilate Anesthesia Atracurium Female Neuromuscular Blocking Agents business Perfusion medicine.drug |
| Zdroj: | University of Groningen |
| ISSN: | 0952-8180 |
| DOI: | 10.1016/s0952-8180(01)00370-1 |
| Popis: | Study Objective: To examine the dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation. Design: Open-label, descriptive study. Setting: University hospital. Patients: 6 ASA physical status III and IV patients with end-stage liver disease, undergoing liver transplantation. Interventions: Neuromuscular transmission was monitored electromyographically. After recovery of T 1 /T 0 to 10%, cisatracurium was infused at an initial rate of 1.5 μ g/kg/min. The infusion rate was adjusted to maintain T 1 /T 0 at 10%. At the end of surgery, spontaneous recovery from the neuromuscular block was awaited. Measurements and Main Results: The infusion rate of cisatracurium was 1.6 ± 0.4 μ g/kg/min. Before the anhepatic phase, this rate was 1.5 ± 0.4 μg/kg/min; during the anhepatic phase it was 1.7 ± 0.5 μg/kg/min; and after reperfusion it was 1.9 ± 0.4 μ g/kg/min. There was a significant difference between the cisatracurium infusion rates before and after the anhepatic phase ( p 1 /T 0 was 19.2 ± 6.1 minutes, the recovery index (25% to 75%) was 28.8 ± 7.0 minutes, and the time for the train-of-four (TOF) ratio to reach 0.7 was 50.2 ± 7.1 minutes. The time for the TOF ratio to reach 0.9 was 61.4 ± 6.6 minutes. There was no difference in body temperature or pH during the consecutive stages of transplantation. Conclusions: The infusion dose requirement for cisatracurium during liver transplantation tended to be higher than previously reported in healthy patients; recovery appeared prolonged. In continuous infusion of cisatracurium during liver transplantation, the tendency toward higher dose requirements, the protracted duration of infusion, the non-Hofmann elimination and/or other pharmacokinetic changes during transplantation might influence recovery from the neuromuscular block. Potential temperature or pH change during surgery seemed irrelevant in explaining the delayed recovery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect