The effect of neuromuscular blockers in patients with intra-abdominal hypertension.
OBJECTIVE
The objective was to prospectively study the effect of neuromuscular blockers on intra-abdominal pressure (IAP) and a number of physiological variables in patients with increased IAP.


METHODS
Prospective cohort study.


METHODS
Intensive care unit of the Ghent University Hospital.


METHODS
Ten critically ill patients with intra-abdominal hypertension (IAH).


METHODS
An intravenous bolus of cisatracurium at a dose of 0.15 mg/kg was administered, and IAP was measured just before administration and then at 15, 30, 60 and 120 min. The effect of cisatracurium on central venous pressure (CVP), mean arterial pressure (MAP), abdominal perfusion pressure (APP) and heart rate (HR) was also evaluated. Urinary output was recorded prior to administration and after 60 and 120 min.


RESULTS
The median age of the patients was 50 years (interquartile range 38-65); five of them were male. APACHE II score on admission was 29 (IQR 14-37). IAH was caused by massive fluid resuscitation without obvious abdominal problem in five patients, by abdominal trauma in three, and by burns and bowel distension in one patient each. Bolus administration of cisatracurium significantly decreased IAP from 18 mmHg (16-20) at baseline to 14 mmHg (12-16) at 15 min (p = 0.01) and to 14 mmHg (13-17) at 30 min (p = 0.02). MAP, APP, CVP and HR remained unchanged. No significant effect on urinary output was observed. In all patients, IAP returned to the baseline level after 2 h.


CONCLUSIONS
Bolus administration of cisatracurium can be used to temporarily reduce IAP in patients with IAH.
De Laet
Inneke
I
Intensive Care Unit 1K12-C, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
Hoste
Eric
E
Verholen
Emmanuel
E
De Waele
Jan J
JJ
D000005:Abdomen; D000328:Adult; D000368:Aged; D001279:Atracurium / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011446:Prospective Studies
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium