مرکز منطقه ای اطلاع رساني علوم و فناوري - Pharmacodynamic effects of cisatracurium during liver transplantation

Abstract :

Aim :Cisatracurium is an advantageous choice of block because of its organ independent Hofmann elimination at physiological pH and temperature in patients undergoing liver transplantation (LT). We aimed to evaluate pharmacodynamic effects and dose requirements of cisatracurium in patients undergoing LT.Material and Methods: The data from 22 LT patients having neuromuscular blockade monitoring were evaluated retrospectively. After induction with propofol and fentanyl, cisatracurium 0.15 mg was administered. Patients were intubated when T1 was below 10%. Anesthesia was maintained with remifentanil and isoflurane. Afterwards, cisatracurium was infused at an initial rate of 1.5 μg/kg/min to maintain T1 below 10% and was continued within ±0.5 μg/kg/min dose changes. Cisatracurium infusion was discontinued at the beginning of the abdominal wall closure and remifentanil and isoflurane at the beginning of the skin closure. When T1 was 25%, atropine and neostigmine were administered. The onset time, clinical duration time, recovery index and the dose requirements of cisatracurium during the operations were evaluated from the records of the patients.Results: The onset time, clinical duration time and recovery index were 240(165-440) s, 50(35-85) min and 8.1(4-18) min, respectively. The dose requirements during the dissection, anhepatic and reperfusion periods were 1.27±0.6, 1.23±0.6, 0.89±0.3 μg/kg/min, respectively. The dose requirement during the reperfusion period was significantly lower than other periods.Conclusion: According to the results of clinical duration time and recovery index, cisatracurium is a proper choice in patients undergoing LT. However, slower onset time in patients requiring rapid intubation and lower dose requirements during reperfusion period must be taken into account.