title: The effect of ulinastatin pre-treatment on vecuronium-induced neuromuscular block in patients with hepatic cirrhosis.
abstract: The aim of this study was to investigate the effect of ulinastatin, a protease inhibitor, on the neuromuscular block produced by vecuronium in patients with hepatic cirrhosis. Thirty adult patients with hepatic cirrhosis were randomly allocated to receive ulinastatin (cirrhosis/ulinastatin group, n = 15) or saline (cirrhosis/saline group, n = 15). Fifteen healthy adult patients without hepatic cirrhosis comprised a control group. Patients were given a standardised anaesthetic that included nitrous oxide and isoflurane in oxygen, and fentanyl. A bolus dose of ulinastatin 5000 unit x kg(-1) was given to members of the cirrhosis/ulinastatin group. The same volume of normal saline was given to the other two groups. Two minutes later, vecuronium 0.1 mg x kg(-1) was given. The onset of neuromuscular block was significantly slower in the cirrhosis/ulinastatin group than in the cirrhosis/saline and control groups (p < 0.05). Spontaneous recovery of neuromuscular function was significantly quicker in the cirrhosis/ulinastatin and control groups than in the cirrhosis/saline group (p < 0.05). The time course of recovery in the cirrhosis/ulinastatin and control groups was similar. We conclude that in cirrhotic patients, ulinastatin delays the onset of neuromuscular block produced by vecuronium. After pretreatment with ulinastatin, the speed of recovery from neuromuscular block in patients with cirrhosis becomes similar to that seen in healthy patients.
authors.affiliation: Department of Anaesthesiology, Fukushima Medical University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Saitoh
authors.forename: K
authors.initials: K
authors.lastname: Kaneda
authors.forename: M
authors.initials: M
authors.lastname: Murakawa
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D005260:Female; D006023:Glycoproteins / Q000494:pharmacology*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D011229:Preanesthetic Medication; D012720:Severity of Illness Index; D013997:Time Factors; D014361:Trypsin Inhibitors / Q000494:pharmacology*; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors* / Q000494:pharmacology
chemical_list: D006023:Glycoproteins; D003473:Neuromuscular Nondepolarizing Agents; D014361:Trypsin Inhibitors; D014673:Vecuronium Bromide; C028665:urinastatin