Comparison of neuromuscular blocking effects of rocuronium given by different methods of administration during liver transplantation / 中华麻醉学杂志

ABSTRACT

Objective To compare the neuromuscular blocking effects of rocuronium given by intermittent bolus injection, continuous infusion and target-controlled infusion during liver transplantation. Methods Thirty-six patients with hepatic failure of both sexes aged 21-63 yr weighing 48-80 kg undergoing liver transplantation were studied. The donor livers were obtained from living donors. The patients were divided into 3 groups according to the mode of rocuronium administration ( n = 12 each) group Ⅰ intermittent bolus injection (group Ⅳ); group Ⅱ continuous infusion (group CI) and group Ⅲ target-controlled infusion (group TCI). Neuromuscular block was assessed by TOF stimulation of ulnar nerve (TOF-Watch SX). Anesthesia was induced with midazolam 5 mg,fentanyl 4-6 μg/kg and propofol 1.0-1.5 mg/kg, and rocuronium was administered using different modes of administration. A bolus of rocuronium 0.6 mg/kg was given during induction and supplemental rocuronium 0.15 mg/kg was given when T1 was returned to 25% in preanhepatic stage and T4/T1 (TOFR) returned to 25% in anhepatic and neohepatic stages in group Ⅳ. TCI at an initial target effect-site concentration of 3 μg/ml was started during induction, the concentration was adjusted to maintain T1 at 5%-10% , TCI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then TCI at a target effect-site concentration of 0.1 μg/ml was started again and the concentration was adjusted to maintain T1 at 5%-10% in group TCI. A bolus of rocuronium 0.6 mg/kg was given during induction, the initial infusion rate was set at 30 μg· kg-1 ·min-1 and then adjusted to maintain T1 at 5%-10% in preanhepatic stage, CI was temporarily suspended at the beginning of anhepatic and neohepatic stages, and then it was started again at 1 μg· kg-1 · min-1 in preanhepatic stage and the infusion rate was adjusted to maintain T1 at 5%-10% in group CI. Tracheal intubation was performed when the maximal effect was achieved. The administration was stopped after suture of the peritoneum. The onset time, the maximal depression of T1 , intubation condition, recovery time and the total amount of rocuronium consumed were recorded.Results There was no significant difference in onset time, the maximal depression of T1, intubation condition,ecovery time and the total amount of rocuronium consumed among the 3 groups ( P ＞ 0.05). Conclusion There is no significant difference in the onset and recovery when neuromuscular blocade was induced by rocuronium via Ⅳ, CI and TCI, but neuromuscular blockade induced by rocuronium via TCI and CI is more stable than that induced by rocuronium via Ⅳ during liver transplantation.