Impact of gender on the dose-effect relationship of cisatracurium / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the impact of gender differences on the dose-effect relationship of cisatracurium.</p><p><b>METHODS</b>Eighty ASA class I or II patients (40 male and 40 female patients) undergoing elective abdominal surgeries received a single-dose intravenous injection of midazolam and fentanyl. The male and female patients were subdivided into 4 equal groups to receive a intravenous bolus of 20, 30, 40, or 50 µg/kg of cisatracurium. The neuromuscular block was measured using a neuromuscular transmission monitor, and the responses were defined in terms of the percentages of maximum suppression in T1 of TOF of the adductor pollicis muscle. According to log-probit transformation of the data of the dose and response, the dose-response curve of cisatracurium was established through linear regression. The onset time of vecuronium was also observed.</p><p><b>RESULTS</b>The ED95 value of cisatracurium in male patients was 67.4±4.4 µg/kg, significantly higher than that in female patients (48.7±1.0 µg/kg, P<0.05). No significant variation in the onset time was found in the 4 dose groups of either male or female patients (P>0.05).</p><p><b>CONCLUSION</b>Female patients are more sensitive to cisatracurium than male patients.</p>

Accuracy of perioperative cardiac preload monitoring by global end-diastolic volume and intrathoracic blood volume in orthotopic liver transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical value of global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBV) in perioperative monitoring of the cardiac preload in patients undergoing orthotopic liver transplantations (OLT).</p><p><b>METHODS</b>Eight ASA III or IV patients aged 42-50 years undergoing OLT without venovenous bypass under general anesthesia were enrolled in this study. Before the induction, a thermodilution femoral artery catheter was inserted into the femoral artery under local anesthesia and connected to a PiCCOplus system to monitor ITBV and GEDV. A CCO catheter was inserted into the right internal jugular vein to monitor the pulmonary artery obstruction pressure (PAOP), central venous press (CVP) and stroke volume (SVPAC). Anesthesia was induced with a combination of midazolam (0.1 mg/kg), propofol (1 mg/kg) and fentanyl (3 microg/kg). Pipecuronium (0.1 mg/kg) was given to facilitate naso-endotracheal intubation. Before anesthesia (T0) and at 10 min before the anhepatic phase (T1), 10 min after anhepatic phase (T2), 10 min after neohepatic phase (T3) and at the end of surgery (T4), all the TPTD and CCO parameters were measured by injecting 10 ml cold saline solution (below 8 degrees celsius;) via the distal port of the central venous catheter.</p><p><b>RESULTS</b>ITBV and GEDV at T2 were significantly lower than those at T0, T1, T3 and T4 (P<0.05). SVPAC at T2 was dramatically decreased compared with that at T0 and T1 (P<0.05). The changes in the pressure preload parameters of the pulmonary artery catheter (PAOP and CVP) did not correlate to the changes in SVPAC, whereas the changes in the volume preload parameters (ITBV and GEDV) of the TPTD was significantly correlated to the changes in SVPAC (P<0.01). PAOP and CVP did not correlate to the changes in ITBV and GEDV.</p><p><b>CONCLUSION</b>ITBV and GEDV are more reliable than PAOP and CVP in perioperative monitoring of the cardiac preload in patients undergoing OLT.</p>