Pharmacodynamics of cisatracurium intravenously infused during liver transplantation / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the pharmacodynamics of cisatracurium intravenously infused during liver transplantation.Methods Twenty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes,aged 18-60 yr,with body mass index of 20-30 kg/m2,scheduled for elective living donor liver transplantation,were enrolled in this study.Total intravenous anesthesia was used.The induction dose of cisatracurium for anesthesia was 0.15 mg/kg.When T1/T0 was restored to 10％,cisatracurium was injected intravenously at an initial rate of 1.5 μg · kg-1 · min-1.The infusion rate was adjusted according to the monitoring results of muscle relaxation,and T1/T0 was maintained at 10％.The total amount of cisatracurium infused and infusing time were recorded during dissection phase,anhepatic phase and neohepatic phase,and the consumption of cisatracurium per unit time was calculated.Before skin incision,at 5 and 30 min of anhepatic phase,at 5 and 30 min of neohepatic phase and at the end of operation,the body temperature and stroke volume variation were recorded,blood samples were collected from the radial artery for blood gas analysis and for measurement of blood K+,Mg2+ and Ca2+ concentrations,and blood samples were collected from the internal jugular vein for determination of serum creatinine (Cr),urea nitrogen (BUN) and β2 microspheres protein (β2-MG) concentrations.Results There was no significant difference in the amount of cisatracurium per unit time between dissection phase and anhepatic phase (P＞0.05).The amount of cisatracurium per unit time was significantly higher in neohepatic phase than in dissection phase and anhepatic phase (P＜0.05).Compared with baseline before skin incision,blood pH value was significantly decreased at 30 min of anhepatie phase and 5 min of neohepatic phase,serum Mg2+concentrations were decreased at 5 and 30 min of neohepatic phase and at the end of operation,the serum Cr,BUN and β2-MG concentrations were increased,the serum Ca2+ concentration was decreased at 5 min of anhepatic phase,and SVV was increased at 5 and 30 min of anhepatic phase (P＜ 0.05 or 0.01).Conclusion Muscle relaxation induced by cisatracurium infused intravenously in the anhepatic phase of liver transplantation is weakened.