ABSTRACT
Forty patients who underwent intermediate elective surgeries were included in the present study. Ten patients were free from hepatic disease [group A], and thirty patients had evident hepatic cirrhosis, [group B]. Using Child-Pugh score, group B patients were further subdivided into three equal subgroups, group B1 was Child A, group B2 patients were Child B and group B3 patients were Child C. Induction of anesthesia was carried out by propofol, fentanyl NO2-O2 and isoflurane. After stabilization of control response using a force displacement transducer and neuromuscular function analyzer, all patients received a bolus of mivacurium 0.15 mg/ kg over 15 seconds [2x ED95] and spontaneous recovery was recorded. Mivacurium infusion was started at T1 of 10% [first response of TOF] and the block was maintained at T1 depression of 95%. Haemodynamic changes were recorded before start of anesthesia and throughout surgery. After bolus injection of mivacuirium, both lag time and onset time didn't show any significant change among groups. Recovery indices were comparable between group A and sub group BO1 [Child A], whereas, there were significant increase of T1 to 10%, 25%, 75% and 90% of control in patients with moderate to severe liver cirrhosis [group B2 and B3] in comparison to group A. TOF ratio of 0. 7 showed the same pattern of change, it was significantly higher in subgroups B2 and B3 in comparison to control group A. Similarly, recovery index was significantly higher in subgroups B2 and B3. The mean infusion requirements of mivacurium were generally less in group B in comparison to group A. Steady state infusion rates were achieved over 10 mm in all groups. Differences in mean mivacurium requirements from 10 min and forward were significantly less in subgroups B2 and B3 in comparison to control A. At end of surgery, residual neuromuscular blockade was antagonized and a TOF ratio of 0.7 was reached in about 7 minutes. None of patients experienced any signs of recurarization in the recovery room. In conclusion, mivacurium has a stable neuromuscular and haemodynamic profile in patients free from hepatic disease and patients of child score A. However, in child score B and C patients the drug profile is unstable and even unpredictable. Therefore, the use of mivacurium is only recommended, if ever, for short procedures in cases of mild liver cirrhosis