Dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation

  • Cammu G
  • Bossuyt G
  • De Baerdemaeker L
 et al. 
  • 6

    Readers

    Mendeley users who have this article in their library.
  • 7

    Citations

    Citations of this article.

Abstract

Study Objective: To examine the dose requirements and recovery profile of an infusion of cisatracurium during liver transplantation. Design: Open-label, descriptive study. Setting: University hospital. Patients: 6 ASA physical status III and IV patients with end-stage liver disease, undergoing liver transplantation. Interventions: Neuromuscular transmission was monitored electromyographically. After recovery of T1/T0to 10%, cisatracurium was infused at an initial rate of 1.5 μg/kg/min. The infusion rate was adjusted to maintain T1/T0at 10%. At the end of surgery, spontaneous recovery from the neuromuscular block was awaited. Measurements and Main Results: The infusion rate of cisatracurium was 1.6 ± 0.4 μg/kg/min. Before the anhepatic phase, this rate was 1.5 ± 0.4 μg/kg/min; during the anhepatic phase it was 1.7 ± 0.5 μg/kg/min; and after reperfusion it was 1.9 ± 0.4 μg/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/T0was 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. © 2002 by Elsevier Science Inc.

Author-supplied keywords

  • Cisatracurium
  • Disease
  • Liver
  • Neuromuscular block
  • Pharmacodynamics
  • Pharmacokinetics
  • Transplantation

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

Authors

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free