rocuronium and Liver-Neoplasms

We report our experience of a patient with a history of anaphylactic shock suspected to be caused by rocuronium who was scheduled to undergo hepatic tumor resection. The patient was a 17-year-old female (height : 166 cm, weight : 46 kg). During general anesthesia at another hospital several years ago, she had an anaphylactic shock, and rocuronium was suspected to be the offending drug. To collect information and search for the cause, skin tests were performed for rocuronium, vecuronium and suxamethonium. She was positive for rocuronium, and negative for other drugs. At anesthesia induction, we administered vecuronium and confirmed no development of anaphylaxis before commencement of surgery. In the perioperative period, she had no symptoms that indicated anaphylaxis. Since there is potential high cross-reactivity among muscle relaxants, it is important to perform a test for alternative drugs when a muscle relaxant may be a cause of anaphylaxis. Selection and administration of an alternative drug should be carefully performed, even when a skin test is negative for the alternative drug.

Topics: Adolescent; Anaphylaxis; Androstanols; Anesthesia, General; Female; Humans; Liver Neoplasms; Perioperative Period; Rocuronium; Skin Tests; Treatment Outcome; Vecuronium Bromide

The effect of rocuronium and sugammadex in patients undergoing hepatectomy due to hepatic tumor without preoperative hepatic impairment were investigated.. We studied 15 patients undergoing hepatectomy and 20 patients undergoing non-hepatic surgery No patients had preoperative hepatic impairment. Anesthesia was induced and maintained with propofol and remifentanil. Train-of-four (TOF) responses of the adductor pollicis to the supramaximal ulnar nerve stimulation were monitored by acceleromyography. A single dose of rocuronium 0.9 mg x kg(-1) was administered, and after spontaneous recovery of T1 to 25%, rocuronium was infused continuously to keep the posttetanic count 1-2. After surgery, sugammadex 4 mg x kg(-1) was administered.. In hepatectomy patients, duration from the administration of rocuronium to recovery of T1 to 25% was longer (88 +/- 20 vs 68 +/- 16 min, P < 0.01), and the total dose of rocuronium used during surgery was less (8.8 +/- 1.7 vs 11.4 +/- 2.7 microg x kg(-1) x min(-1), P < 0.01). However, there were no differences in the duration from administration of sugammadex to recovery of TOF ratio to 0.9 between two groups (138 +/- 55 vs 164 +/- 79 sec, P = 0.29).. Rocuronium-induced neuromuscular block was prolonged in hepatectomy patients even without preoperative hepatic impairment but the reversal with sugammadex was effective.

Topics: Aged; Androstanols; Anesthesia Recovery Period; Female; gamma-Cyclodextrins; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex; Time Factors

To determine the effect of liver disease on the pharmacokinetics of rocuronium, the authors administered 0.6 mg/kg (twice the ED95) to 10 patients with liver disease and compared these results to values in 10 healthy surgical patients. Anesthesia was induced with thiopental and maintained with isoflurane (0.9%-1.1% end-tidal concentration) and nitrous oxide (60%). Venous blood samples were obtained for 6 h after rocuronium injection and plasma concentrations were measured using gas chromatography. Pharmacokinetic differences between groups were determined using a population-based pharmacokinetic analysis (NONMEM). Hepatic impairment did not alter the plasma clearance of rocuronium (217 +/- 21.8 mL/min, mean +/- SE, for both groups), but did increase the volume of the central compartment (5.96 +/- 1.01 L for controls, 7.87 +/- 1.33 L for patients with liver disease) and volume of distribution at steady state (16.4 L for controls, 23.4 L for patients with liver disease). In turn, elimination half-life was longer in patients with liver disease (111 min) compared to controls (75.4 min). The authors conclude that liver disease alters the pharmacokinetics of rocuronium by increasing its volume of distribution. The longer elimination half-life might result in a longer duration of action of rocuronium in patients with liver disease, particularly after prolonged administration.

Topics: Adult; Aged; Androstanols; Anesthesia; Carcinoma, Hepatocellular; Evoked Potentials; Female; Half-Life; Humans; Liver Cirrhosis, Alcoholic; Liver Neoplasms; Male; Middle Aged; Muscle Contraction; Neuromuscular Depolarizing Agents; Rocuronium