title: Rocuronium profile during orthotopic liver transplantation: effect of changing the order of vascular clamp release at reperfusion of the hepatic graft.
abstract: BACKGROUND
  Clearance of rocuronium in the neohepatic period may be a criterion for graft function during orthotopic liver transplantation (OLT). Our goal was to demonstrate that changes in rocuronium elimination are caused mainly by variations in blood volume at reperfusion. We have explored the influence on rocuronium plasma concentrations of changing the order of vascular unclamping at graft reperfusion.
  
  
  METHODS
  Thirty patients were randomized at graft reperfusion: initial arterial revascularization (IAR; n = 14) wherein the hepatic artery was released first, and initial portal revascularization (IPR; n = 16) wherein the portal vein was released first. Tracheal intubation was facilitated by rocuronium (1 mg/kg) with an infusion initiated at 0.25 mg kg(-1) h(-1) to maintain a response to the first stimulus of the train of four <25% of controls. Rocuronium plasma concentrations (RPC) were measured throughout the transplantation.
  
  
  RESULTS
  No differences were observed in rocuronium consumption at different stages. RPCs decreased after reperfusion, with primarily portal unclamping responsible. In 6 patients of the IAR group and 5 patients of the IPR group, RPC at 60 minutes after reperfusion was higher than previous values. Indicators of graft dysfunction among those 11 did not differ from the other patients. Two patients in the IPR group required retransplantation without any relation to changes in RPCs.
  
  
  CONCLUSIONS
  The increase of blood flow produced by portal vein unclamping influenced RPCs; no relation was observed between RPCs and graft outcomes.
authors.affiliation: Department of Anesthesia, Hospital Universitari de Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain. asabatep@bellvitgehospital.cat
authors.forename: A
authors.initials: A
authors.lastname: Sabaté
authors.forename: E
authors.initials: E
authors.lastname: Ferreres
authors.forename: M
authors.initials: M
authors.lastname: Valcárcel
authors.forename: A
authors.initials: A
authors.lastname: Dalmau
authors.forename: M
authors.initials: M
authors.lastname: Koo
authors.forename: J
authors.initials: J
authors.lastname: Fabregat
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage / Q000097:blood; D003250:Constriction; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007262:Infusions, Intravenous; D007440:Intubation / Q000379:methods; D008102:Liver Circulation / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D011169:Portal Vein / Q000601:surgery; D015424:Reperfusion / Q000379:methods; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium