NDLI: Vecuronium requirements according to the operative phase during living donor liver transplantation under desflurane anesthesia.

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Vecuronium requirements according to the operative phase during living donor liver transplantation under desflurane anesthesia.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kim, W. H. Joo, H. S. Ko, J. S. Gwak, M. S. Lee, S. K. Kim, G. S.
Description	Author Affiliation: Kim WH ( Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.)
Abstract	INTRODUCTION: The requirements of nondepolarizing neuromuscular blocking agent during liver transplantation show conflicting results. We sought to evaluate the requirements according to the operative phase and find extrahepatic factors that influence neuromuscular blocking agent requirements. METHODS: We enrolled 35 patients undergoing living donor liver transplantation. Continuous infusion of vecuronium was adjusted every 15 minutes for consistent neuromuscular blockade aimed at T1/Tc of 0.10 monitored with a neuromuscular transmission module. We compared the mean infusion dose in each phase, and investigated whether it is correlated with preoperative Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, graft-recipient weight ratio (GRWR), or time to recovery of first twitch response to train-of-four (TOF) stimulation. RESULTS: There was a significant difference between vecuronium doses during each phase (P < .001): 0.48 ± 0.16 µg/kg/min, preanhepatic; 0.38 ± 0.14 µg/kg/min, anhepatic and 0.26 ± 0.07 µg/kg/min, neohepatic phase. There was a significant positive correlation between vecuronium infusion dose in the preanhepatic phase and CTP scores (P = .006, correlation coefficient = 0.465). There was also a significant negative correlation between the time to recovery of first twitch response of TOF stimulation and vecuronium infusion dose in the preanhepatic phase (P = .001, correlation coefficient = -0.546). The infusion dose during the preanhepatic phase was not associated with the MELD score, and that of neohapatic phase not with GRWR. CONCLUSIONS: The vecuronium infusion dose requirement during the anhepatic decreased compared with that in the preanhepatic phase. It further decreased during the neohepatic phase compared with the previous phases. Vecuronium infusion dose reduction is suggested especially during the neohepatic phase for early extubation. The dose during the preanhepatic phase is suggested to be determined considering the CTP score and the time to recovery of the TOF response.
File Format	HTM / HTML
ISSN	00411345
Issue Number	5
Volume Number	45
e-ISSN	18732623
Journal	Transplantation Proceedings
Language	English
Publisher	Elsevier
Publisher Date	2013-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Transplantation__semicolon__medicine Anesthetics, Inhalation Administration & Dosage Isoflurane Analogs & Derivatives Liver Transplantation Living Donors Vecuronium Bromide Humans Prospective Studies Journal Article
Content Type	Text
Resource Type	Article
Subject	Transplantation Surgery

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