Duration of Rocuronium-Induced Neuromuscular Block During Liver Transplantation

Marcel, Randy J.; Ramsay, Michael A. E.; Hein, H. A. Tillmann; Nguyen, Anh-Thuy T; Ramsay, Kirsten J.; Suit, C. Tracy; Miller, Ronald D.

doi:10.1213/00000539-199704000-00031

Cited by 20 publications

(5 citation statements)

References 10 publications

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“…Concerns exist around the impaired metabolism of aminosteroid muscle relaxants in patients with significantly impaired liver function. 38 It is our experience with rocuronium that prolonged muscle relaxation at the conclusion of surgery is seldom a problem in the presence of a functioning liver graft and that the stable hemodynamics seen with aminosteroid muscle relaxant use are beneficial. Some authors have suggested that impaired metabolism of rocuronium is a useful early sign of primary graft nonfunction.…”

Section: Induction and Monitoringmentioning

confidence: 99%

“…Some authors have suggested that impaired metabolism of rocuronium is a useful early sign of primary graft nonfunction. 38 Induction of anesthesia should be undertaken with a rapid-sequence induction, using succinylcholine and cricoid pressure if the patient is unfasted, suffers from or is at high risk for gastroesophageal bleeding, or has a history that suggests impaired gastric emptying. In the absence of these symptoms, a high-dose nondepolarizing muscle relaxant is appropriate and gives similar time of onset to paralysis.…”

Section: Induction and Monitoringmentioning

confidence: 99%

“…Some authors have suggested that impaired metabolism of rocuronium is a useful early sign of primary graft nonfunction. 38…”

Section: Anesthesia Management Of the Liver Transplant Proceduresmentioning

confidence: 99%

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Anesthesia for Liver Transplantation

Hall

Dhir

2013

Semin Cardiothorac Vasc Anesth

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Orthotopic liver transplantation is the only definitive treatment for end-stage liver disease. More than 6000 procedures are performed in the United States annually with excellent survival rates. The shortage of donor organs leads to continued interest in techniques to enlarge the potential donor pool. Patients presenting for liver transplant suffer from important cardiovascular, respiratory, renal, neurological, and gastroenterological comorbidity. In the Western world, liver failure is increasingly caused by steatohepatitis, and transplant candidates are thus becoming older and more comorbid. The role of the transplant anesthesiologist is highly important in the preoperative assessment, intraoperative management, and postoperative care of these complex and sick patients. Appropriate investigation and management of comorbidities such as coronary artery disease and portopulmonary hypertension is controversial and differs between programs. The transplant procedure is a major surgery, and although massive transfusion is no longer commonplace, there is potential for significant hemodynamic instability, coagulopathy, and metabolic disturbance. Liver transplant surgery can be divided into the preanhepatic phase, the anhepatic phase, and the reperfusion phase, with important anesthetic considerations at each point. An understanding of the surgical techniques used for vascular exclusion of the liver and the role of venovenous bypass is crucial for the anesthesiologist. Recent trends in perioperative care include the use of antifibrinolytic drugs and point-of-care coagulation tests, intraoperative renal replacement therapy, and "fast-track" extubation and postoperative care. Care of patients with fulminant hepatic failure or those receiving split-liver grafts requires special consideration.

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Section: Induction and Monitoringmentioning

confidence: 99%

Section: Induction and Monitoringmentioning

confidence: 99%

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Anesthesia for Liver Transplantation

Hall

Dhir

2013

Semin Cardiothorac Vasc Anesth

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“…The new liver graft may be evaluated by vecuronium since the time for the return of a train-of-four (TOF) with a nerve stimulator correlates with the function of the new liver (Lukin et al, 1995). Similarly, the duration of action of rocuronium is also used for the assessment of allograft function; >150 minutes refers to allograft dysfunction (Marcel et al, 1997).…”

Section: Anesthetic Induction and Maintenancementioning

confidence: 99%

Anesthesia in Liver Transplantation

Dilip¹

2010

Liver Transplantation

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“…Early assessment of graft liver function during liver transplantation in humans by measuring neuromuscular blockade induced by vecuronium or rocuronium has been studied recently 63,64 , demonstrating a significant correlation between the recovery time from neuromuscular blockade and graft liver function during the early postoperative period. A statistically significant prolongation of recovery times for both drugs was observed in patients with primary dysfunction after transplantation.…”

Section: Nondepolarizing Neuromuscular Blocking Agentsmentioning

confidence: 99%

Potential Use of Pharmacological Markers to Quantitatively Assess Liver Function during Liver Transplantation Surgery

Gao

Ramzan

2000

Anaesth Intensive Care

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Early functioning of the transplanted liver is of crucial importance to the recipient. This function may be assessed by measuring the disposition of substances that are mainly eliminated via the liver. None of the agents currently used is ideal for this purpose. Measurement of mono-ethyleneglycinexylidide (MEGX) formation from lignocaine is useful and has been widely used in liver transplantation to assess liver graft function. MEGX formation can be affected by the use of drugs that influence liver perfusion or interfere with the CYP450 enzyme system. Indocyanine green clearance is a convenient method but both blood flow and hepatocellular function affect the test results. Tests of caffeine clearance, galactose elimination capacity and antipyrine clearance all require time-consuming, technically cumbersome and expensive serial blood sampling. The aminopyrine breath test is non-invasive, but gastric emptying and the patient's physical state affect results. The potential hazard of exposure to radioactive compounds limits the wide clinical use of both aminopyrine and erythromycin breath tests. Monitoring the rate of recovery from neuromuscular blockade induced by vecuronium and rocuronium can provide valuable information on liver function.

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Duration of Rocuronium-Induced Neuromuscular Block During Liver Transplantation

Cited by 20 publications

References 10 publications

Anesthesia for Liver Transplantation

Anesthesia for Liver Transplantation

Anesthesia in Liver Transplantation

Potential Use of Pharmacological Markers to Quantitatively Assess Liver Function during Liver Transplantation Surgery

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