rocuronium and Liver-Failure

How to titrate rocuronium under the specific conditions such as hepatic/renal failure, hypothermia, acidosis, and baby/aged, obese, with antibiotics, type of anesthetics, operation site and continuous infusion was discussed.

Topics: Acidosis; Age Factors; Androstanols; Anesthetics; Anti-Bacterial Agents; Drug Interactions; Humans; Hypothermia; Liver Failure; Neuromuscular Nondepolarizing Agents; Obesity; Renal Insufficiency; Rocuronium; Time Factors

Mivacurium is a short-acting nondepolarising muscle relaxant of the benzylisoquinoline type undergoing rapid breakdown by plasma cholinesterase. With 2.5 fold ED95, tracheal intubation can be accomplished within 2-3 min following injection. The ensuing DUR 25% (i.e. time from injection to 25% recovery of control twitch tension) is three times as long as with succinylcholine and about half as long as with equipotent doses of atracurium and vecuronium. The principal side effects of mivacurium are facial flushing and a transient fall in blood pressure due to a moderate histamine release following doses of 3-4 times the ED95. In patients with end stage liver or renal disease as well as in patients with atypical plasma cholinesterase the duration of action of mivacurium is prolonged. Rocuronium is a steroidal non-depolarising neuromuscular blocking agent chemically related to vecuronium. Compared with the latter, rocuronium is less potent, has a shorter onset of action, and no cumulative effects. Adequate intubating conditions are achieved within 60 to 90 s after i.v. injection of twice the ED95. Its elimination from the blood occurs primarily via liver uptake, while renal elimination is about 10 to 30%. Slight vagolytic effects are reported following injection of 0.6 mg/kg rocuronium, while histamine release is unlikely to occur. Atracurium is a mixture of ten stereoisomers. One of them, cis-atracurium, is five times as potent as the chiral mixture while having a similar pharmacodynamic and kinetic profile. It does not cause significant histamine release or clinically relevant cardiovascular effects at doses up to 8 times the ED95. Laudanosine release seems to be less with cis-atracurium than with atracurium.

Topics: Androstanols; Anesthesia, Endotracheal; Anesthesia, General; Atracurium; Biotransformation; Dose-Response Relationship, Drug; Humans; Isoquinolines; Liver Failure; Metabolic Clearance Rate; Mivacurium; Neuromuscular Nondepolarizing Agents; Preanesthetic Medication; Renal Insufficiency; Rocuronium

The liver and kidney functions of recipients of liver transplantation (LT) surgery with heart beating (HBD, n = 13) or living donors (LD, n = 9) with different cold ischemia times were examined during the neohepatic phase for the elimination of rocuronium bromide (ROC, cleared by liver and kidney) and tranexamic acid (TXA, cleared by kidney). Solid phase micro-extraction and LC-MS/MS was applied to determine the plasma concentrations of ROC and TXA, and creatinine was determined by standard laboratory methods. Metabolomics and the relative expressions of miR-122, miR-148a and γ-glutamyltranspeptidase (GGT), liver injury biomarkers, were also measured. The ROC clearance for HBD was significantly lower than that for LD (0.147 ± 0.052 vs. 0.265 ± 0.148 ml·min

Topics: Adult; Aged; Androstanols; Biomarkers; Female; gamma-Glutamyltransferase; Humans; Liver Failure; Liver Transplantation; Male; Metabolomics; MicroRNAs; Middle Aged; Models, Biological; Pilot Projects; Rocuronium; Tissue Donors; Tranexamic Acid