Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans.
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.
Weng
Xiao-Chuan
XC
Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. wengxc1973@hotmail.com
Zhou
Liang
L
Fu
Yin-Yan
YY
Zhu
Sheng-Mei
SM
He
Hui-Liang
HL
Wu
Jian
J
D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001279:Atracurium / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D008099:Liver / Q000378:metabolism; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000077123:Rocuronium
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D000077123:Rocuronium