ABSTRACT
Background: Although diaphragm ultrasound can be used for detecting residual neuromuscular blockade post-surgery, there exists notable dearth in contemporary research exploring the correlation between preoperative Child-Pugh classification and the effectiveness of sugammadex in reversing rocuronium-induced blockade as evaluated by diaphragmatic ultrasonography. Methods: This was a prospective, double-blind, non-randomized controlled clinical trial conducted on patients scheduled for laparoscopic liver resection surgery. The participants were categorized into two groups, A and B, based on their preoperative Child-Pugh classification. Prior to anesthesia induction, baseline diaphragm thickness was evaluated using ultrasonography. Throughout the surgical procedure, a deep neuromuscular blockade was maintained with rocuronium. Post-surgery, sugammadex (2 mg/kg) was intravenously administered to patients in both groups upon reaching a train-of-four ratio of 0.2. Diaphragm thickness was assessed at 0, 10, and 30 min, as well as 2 h after extubation, to analyze thickening fractioning (TF) and thickness recovery fractioning (TRF). Results: No significant differences in TF or TRF were observed between the two groups at 0, 10, and 30 min, as well as 2 h after extubation. Furthermore, there were no significant variances in hemodynamic stability following sugammadex administration. However, patients in the Child-Pugh B group experienced a significantly prolonged time from sugammadex administration to tracheal extubation (19 ± 8.0 min vs. 11 ± 6.1 min) and an extended post-anesthesia care unit stay (123 ± 28.3 min vs. 103 ± 26.0 min) compared to those in the Child-Pugh A group. Conclusion: The preoperative Child-Pugh grades may not exhibit a significant association with the reversal effect of sugammadex on rocuronium, as evaluated through diaphragmatic ultrasonography. Clinical trial registration: Registered in the ClinicalTrials.gov (NCT05028088) on July 18, 2021.
ABSTRACT
Objective:To investigate the relationship between the level of plasma ammonia(NH3),and the changes of serum alpha-fetoprotein(AFP),cholinesterase(ChE),liver fibrosis index in liver cirrhosis patients with hepatocellular carcinoma(LC-HCC)in reference to Child-pugh grades.Methods: A total of 58 patients with LC and HCC(LC-HCC group),76 patients with LC(LC group)and 60 cases of healthy volunteers(HC group)were collected.Serum AFP were detected by electrochemiluminescence,serum Hyaluronic acid(HA),laminin(LN),type Ⅳ collagen(Ⅳ-C) were detected by chemilu minescence immunoassay,serum ChE were detected by S-Butyrylthiocholine iodide,NH3 was continuously monitored.The levels of AFP,ChE,NH3 and liver fibrosis indexes(HA,LN,Ⅳ-C) among the LC-HCC group,LC group and HC group,different Child-Pugh grades in LC-HCC group were compared.Results: The serum levels of NH3,AFP,HA,LN,Ⅳ-C in LC-HCC group were significantly higher than that in LC and HC group,and ChE levels were significantly reduced,differences between LC group and HC group were statistically significant(P<0.05).With the increase of Child-Pugh grades,the serum levels of NH3,AFP,HA,LN,Ⅳ-C in LC-HCC group were gradually increased but the ChE gradually decreased,the differences were statistically significant(P<0.05).Serum levels of ChE in patients with LC-HCC were significant negatively correlated with Child-Pugh grades,and AFP,NH3,HA,LN,Ⅳ-C were significant positive correlated with Child-Pugh grades(P<0.05).Serum levels of ChE in patients with LC-HCC were significant negatively correlated with LN,Ⅳ-C and HA,while the levels of AFP,NH3 were significant positive correlated with LN,Ⅳ-C and HA(P<0.05).Conclusion: The serum levels of AFP,ChE and NH3 in patients with LC and HCC are significant abnormalities;they are significant positive correlated with Child-Pugh grades;the detection of the these indicators is valuable to non-invasive diagnosis for patients with LC and HCC.