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Journal of Zhejiang University SCIENCE B 2005 Vol.6 No.9 P.869-872

http://doi.org/10.1631/jzus.2005.B0869


Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans


Author(s):  WENG Xiao-chuan, ZHOU Liang, FU Yin-yan, ZHU Sheng-mei, HE Hui-liang, WU Jian

Affiliation(s):  Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more

Corresponding email(s):   wengxc1973@hotmail.com, zzok@hotmail.com

Key Words:  Rocuronium, Atracurium, Orthotopic liver transplantation


WENG Xiao-chuan, ZHOU Liang, FU Yin-yan, ZHU Sheng-mei, HE Hui-liang, WU Jian. Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans[J]. Journal of Zhejiang University Science B, 2005, 6(9): 869-872.

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author="WENG Xiao-chuan, ZHOU Liang, FU Yin-yan, ZHU Sheng-mei, HE Hui-liang, WU Jian",
journal="Journal of Zhejiang University Science B",
volume="6",
number="9",
pages="869-872",
year="2005",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.2005.B0869"
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%T Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans
%A WENG Xiao-chuan
%A ZHOU Liang
%A FU Yin-yan
%A ZHU Sheng-mei
%A HE Hui-liang
%A WU Jian
%J Journal of Zhejiang University SCIENCE B
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%D 2005
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.2005.B0869

TY - JOUR
T1 - Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans
A1 - WENG Xiao-chuan
A1 - ZHOU Liang
A1 - FU Yin-yan
A1 - ZHU Sheng-mei
A1 - HE Hui-liang
A1 - WU Jian
J0 - Journal of Zhejiang University Science B
VL - 6
IS - 9
SP - 869
EP - 872
%@ 1673-1581
Y1 - 2005
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.2005.B0869


Abstract: 
Objective: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. Methods: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%~10%. The total dose of each drug given during each of the three phases of OLT was recorded. Results: rocuronium requirement, which were (0.468±0.167) mg/(kg·h) during the paleohepatic phase, decreased significantly during the anhepatic phase to (0.303±0.134) mg/(kg·h) and returned to the initial values at the neohepatic period ((0.429±0.130) mg/(kg·h)); whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. Conclusions: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1] Farman, J.V., Turner, J.M., Blanloeil, Y., 1986. Atracurium infusion in liver transplantation. Br. J. Anaesth., 58(Suppl 1):96S-102S.

[2] Fisher, D.M., Canfell, P.C., Fahey, M.R., Rosen, J.I., Rupp, S.M., Sheiner, L.B., Miller, R.D., 1986. Elimination of atracurium in humans: Contribution of Hofmann elimination and ester hydrolysis versus organ-based elimination. Anesthesiology, 65(1):6-12.

[3] Fisher, D.M., Ramsay, M., Hein, T., Marcel, R.J., Sharma, M., Ramsay, K.J., Miller, R.D., 1997. Pharmacokinetics of rocuronium during the three stages of liver transplantation. Anesthesiology, 86(6):1306-1316.

[4] Gao, L., Ramzan, I., Baker, B., 2002. Rocuronium plasma concentrations during three phases of liver transplantation: Relationship with early postoperative graft liver function. Br. J. Anaesth., 88(6):764-770.

[5] Gao, L., Ramzan, I., Baker, B., 2003. Rocuronium infusion requirements and plasma concentrations at constant levels of neuromuscular paralysis during three phases of liver transplantation. J. Clin. Anesth., 15(4):257-266.

[6] Khuenl-Brady, K., Castagnoli, K.P., Canfell, P.C., Caldwell, J.E., Agostan, S., Miller, R.D., 1990. The neuromuscular blocking effects and pharmacokinetics of ORG9426 and ORG9616 in the cat. Anesthesiology, 72(4):669-674.

[7] Magorian, T., Wood, P., Caldwell, J., Fisher, D., Segredo, V., Szenohradszky, J., Sharma, M., Gruenke, L., Miller, R., 1995. The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease. Anesth. Analg., 80(4):754-759.

[8] O’Kelly, B., Jayais, P., Veroli, P., Lhuissier, C., Ecoffy, C., 1991. Dose requirements of vecuronium, pancuronium, and atracurium during orthotopic liver transplantation. Anesth. Analg., 73(6):794-798.

[9] Pitter, J.F., Tassonyi, E., Schopfer, C., Morel, D.R., Mentha, G., Fathi, M., Le Coultre, C., Steinig, D.A., Benakis, A., 1990. Plasma concentrations of laudanosine, but not of atracurium, are increased during the anhepatic phase of orthotopic liver transplantation in pigs. Anesthesiology, 72(1):145-152.

[10] Ward, S., Neill, E.A., 1983. Pharmocokinetics of atracurium in acute hepatic failure (with acute renal failure). Br. J. Anaesth., 55(12):1169-1172.

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