Influence of obstructive jaundice on neuromuscular blocking effect and drug metabolism of rocuronium / 第二军医大学学报

ABSTRACT

Objective: To observe the effect of obstructive jaundice on the neuromuscular blocking effect and drug metabolism of rocuronium, so as to guide proper use of rocuronium during anesthesia for patients undergoing hepatobiliary surgeries. Methods: Thirty patients (with normal renal function and without muscle or nerves diseases, ASA I - II) receiving elective surgery were divided into 2 groups: obstructive jaundice group (group I, n=15) and control group (group II, n=15). All patients received continuous peridural anesthesia and general anesthesia. Neuromuscular blockade was evaluated with train-of-four (TOF) stimuli of the ulnsar nerve using TOF Watch SX nerve stimulators. The onset time, clinical duration of rocuronium, the time of TOFR from 0 to 70% and recovery index (T1 from 25%-75%) were observed. Liquid chromatography-tandem mass spectrometry (LC/MS/MS) was used to determine the concentration of rocuronium in the plasma at 30, 60, 90, 120, and 180 min after administration of 0. 9 mg/kg rocuronium. Results: The age, body mass index, and prothrombin time were matched between the two groups. The total bilirubin, direct bilirubin and indirect bilirubin in group I were significantly higher than that in group II (P<0.01). The onset time was similar between the two groups; the clinical duration of rocuronium, the time of TOFR from 0 to 70%, and the recovery index (to 10%, 25%, 50%, and 75% of T1) in group I were significantly longer than those in group II (P<0.01). The plasma concentrations of rocuronium in group I were significantly higher than those in group II at 60, 90, 120 min after administration of rocuronium (P<0. 01 or P<0.05). Conclusion: Obstructive jaundice may prolong the duration of rocuronium action and recovery time, and slows down the metabolism of rocuronium. So patients with obstructive jaundice should have a longer interval for drug addition. Peri- and post-operative monitoring of neuromuscular function is suggested for proper drug use and anesthesia extubation.