Dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation.
OBJECTIVE
To examine the dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation.


METHODS
Open-label, descriptive study.


METHODS
University hospital.


METHODS
6 ASA physical status III and IV patients with end-stage liver disease, undergoing liver transplantation.


METHODS
Neuromuscular transmission was monitored electromyographically. After recovery of T1/T0 to 10%, cisatracurium was infused at an initial rate of 1.5 microg/kg/min. The infusion rate was adjusted to maintain T1/T0 at 10%. At the end of surgery, spontaneous recovery from the neuromuscular block was awaited.


RESULTS
The infusion rate of cisatracurium was 1.6 +/- 0.4 microg/kg/min. Before the anhepatic phase, this rate was 1.5 +/- 0.4 microg/kg/min; during the anhepatic phase it was 1.7 +/- 0.5 microg/kg/min; and after reperfusion it was 1.9 +/- 0.4 microg/kg/min. There was a significant difference between the cisatracurium infusion rates before and after the anhepatic phase (p < 0.05). Following termination of the infusion, the time to 25% recovery of T1/T0 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.
Cammu
Guy
G
Department of Anesthesia, Ghent University Hospital, Belgium. Guy.Cammu@olvz-aalst.be
Bossuyt
Gudrun
G
De Baerdemaeker
Luc
L
Den Blauwen
Nadia
N
Struys
Michel
M
Mortier
Eric
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D001279:Atracurium / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D004576:Electromyography; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D009469:Neuromuscular Junction / Q000502:physiology; D009435:Synaptic Transmission
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium