Influence of the Pringle maneuver during partial hepatectomy on the neuromuscular block induced by intermittent and continuous dosing of rocuronium.
Neuromuscular block
Plasma concentration
Pringle maneuver
Rocuronium
Journal
Journal of anesthesia
ISSN: 1438-8359
Titre abrégé: J Anesth
Pays: Japan
ID NLM: 8905667
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
10
05
2023
accepted:
27
07
2023
medline:
17
11
2023
pubmed:
7
8
2023
entrez:
7
8
2023
Statut:
ppublish
Résumé
The Pringle maneuver (PM) is a common procedure in hepatectomy that is known to interrupt drug elimination. The purpose of this study was to examine the influence of PM on the duration of action of rocuronium administered by intermittent bolus dosing, the continuous rocuronium infusion dose required for maintenance of a moderate neuromuscular block, and changes in plasma concentrations of rocuronium. Twenty-seven adult patients undergoing partial hepatectomy with PM were enrolled in this study. The duration of action of 0.2 mg/kg rocuronium boluses (DUR), and the continuous rocuronium infusion dose required for maintenance of the height of the first twitch of the train-of-four (T1) at 10-20% of the control value (%T1), respectively, were electromyographically monitored on the adductor digiti minimi muscle. The effects of PM on DUR, %T1, and the plasma concentration of rocuronium were measured. The DUR was significantly prolonged during PM [mean: 42.2 (SD: 8.0) min, P < 0.001] compared to baseline [29.7 (6.3) min]. It was prolonged even after completion of the PM [46.2 (10.5) min, P < 0.001]. The plasma concentration of rocuronium measured at every reappearance of T1 was comparable between before and during PM. %T1 [15.5 (5.6)%] was significantly depressed after the start of PM [6.5 (3.9)%, P < 0.001], with persistence of the depression even after completion of PM. However, there were no significant changes in the plasma concentration of rocuronium. Rocuronium-induced neuromuscular block is significantly augmented during PM. However, the augmentation is not associated with an increase in plasma rocuronium concentration.
Identifiants
pubmed: 37548656
doi: 10.1007/s00540-023-03239-8
pii: 10.1007/s00540-023-03239-8
doi:
Substances chimiques
Rocuronium
WRE554RFEZ
Androstanols
0
Neuromuscular Nondepolarizing Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
828-834Informations de copyright
© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.
Références
Khuenl-Brady K, Castagnoli KP, Canfell C, Caldwell JE, Agoston S, Miller RD. The neuromuscular blocking effects and pharmacokinetics of ORG 9426 and ORG 9616 in the cat. Anesthesiology. 1990;72:669–74.
doi: 10.1097/00000542-199004000-00016
pubmed: 1969717
Proost JH, Eriksson LI, Mirakhur RK, Roest G, Wierda JMKH. Urinary, biliary and faecal excretion of rocuronium in humans. Br J Anaesth. 2000;85:717–23.
doi: 10.1093/bja/85.5.717
pubmed: 11094587
Costa ACC, Coelho EB, Lanchote VL, Lanchote VL, Correia BV, Abumansur JT, Lauretti GR, de Moraes NV. The SLCO1A2-189_-188InsA polymorphism reduces clearance of rocuronium in patients submitted to elective surgeries. Eur J Clin Pharmacol. 2017;73:957–63.
doi: 10.1007/s00228-017-2243-1
pubmed: 28409297
Ahlström S, Bergman P, Jokela R, Ottensmann L, Ahola-Olli A, Pirinen M, Olkkola KT, Kaunisto MA, Kalso E. First genome-wide association study on rocuronium dose requirements shows association with SLCO1A2. Br J Anaesth. 2021;126:949–57.
doi: 10.1016/j.bja.2021.01.029
pubmed: 33676726
pmcid: 8132880
van Miert MM, Eastwood NB, Boyd AH, Parker CJ, Hunter JM. The pharmacokinetics and pharmacodynamics of rocuronium in patients with hepatic cirrhosis. Br J Clin Pharmacol. 1997;44:139–44.
doi: 10.1046/j.1365-2125.1997.00653.x
pubmed: 9278198
pmcid: 2042830
Servin FS, Lavaut E, Kleef U, Desmonts JM. Repeated doses of rocuronium bromide administered to cirrhotic and control patients receiving isoflurane. A clinical and pharmacokinetic study. Anesthesiology. 1996;84:1092–100.
doi: 10.1097/00000542-199605000-00011
pubmed: 8624003
Magorian T, Wood P, Caldwell J, Fisher D, Segredo V, Szenohradszky J, Sharma M, Gruenke L, Miller R. The pharmacokinetics and neuromuscular effects of rocuronium bromide in patients with liver disease. Anesth Analg. 1995;80:754–9.
pubmed: 7893030
Yang JJ, Wang YG, Zhang Z, Zhang ZJ, Liu J, Xu JG. Pharmacodynamics of rocuronium in cholestatic patients with or without hepatocellular injury: normal onset time of initial dose and prolonged duration time after repeated doses. J Pharm Pharm Sci. 2008;11:15–21.
doi: 10.18433/J3RG6W
pubmed: 18801303
Wang ZM, Zhang P, Lin MJ, Tan B, Qiu HB, Yu WF. Influence of obstructive jaundice on pharmacodynamics of rocuronium. PLoS ONE. 2013;8: e78052.
doi: 10.1371/journal.pone.0078052
pubmed: 24147111
pmcid: 3797760
Khalil M, D’Honneur G, Duvaldestin P, Slavov V, De Hys C, Gomeni R. Pharmacokinetics and pharmacodynamics of rocuronium in patients with cirrhosis. Anesthesiology. 1994;80:1241–7.
doi: 10.1097/00000542-199406000-00011
pubmed: 8010470
Liu Y, Cao W, Liu Y, Wang Y, Lang R, Yue Y, Wu AS. Changes in duration of action of rocuronium following decrease in hepatic blood flow during pneumoperitoneum for laparoscopic gynaecological surgery. BMC Anesthesiol. 2017;17:45.
doi: 10.1186/s12871-017-0335-1
pubmed: 28320323
pmcid: 5359965
Kajiura A, Nagata O, Sanui M. The Pringle maneuver reduces the infusion rate of rocuronium required to maintain surgical muscle relaxation during hepatectomy. J Anesth. 2018;32:409–13.
doi: 10.1007/s00540-018-2498-4
pubmed: 29704050
Wierda JM, Kleef UW, Lambalk LM, Kloppenburg WD, Agoston S. The pharmacodynamics and pharmacokinetics of Org 9426, a new non-depolarizing neuromuscular blocking agent, in patients anaesthetized with nitrous oxide, halothane and fentanyl. Can J Anaesth. 1991;38:430–5.
doi: 10.1007/BF03007578
pubmed: 1829656
Wierda JM, Proost JH, Schiere S, Hommes FD. Pharmacokinetics and pharmacokinetic/dynamic relationship of rocuronium bromide in humans. Eur J Anaesthesiol Suppl. 1994;9:66–74.
pubmed: 7925212
Kajiura A, Nagata O, Takizawa Y, Nakatomi T, Kodera S, Murayama T. A large individual variation in both the infusion rate and the blood concentration of rocuronium necessary for obtain adequate surgical muscle relaxation during total intravenous anesthesia with propofol and remifentanil. J Anesth. 2015;29:9–14.
doi: 10.1007/s00540-014-1879-6
pubmed: 24997090
Fisher DM, Ramsay MA, Hein HA, Marcel RJ, Sharma M, Ramsay KJ, Miller RD. Pharmacokinetics of rocuronium during the three stages of liver transplantation. Anesthesiology. 1997;86:1306–16.
doi: 10.1097/00000542-199706000-00012
pubmed: 9197300
Brandoni A, Villar SR, Picena JC, Anzai N, Endou H, Torres AM. Expression of rat renal cortical OAT1 and OAT3 in response to acute biliary obstruction. Hepatology. 2006;43:1092–100.
doi: 10.1002/hep.21142
pubmed: 16628676
Wang L, Zhou MT, Chen CY, Yin W, Wen DX, Cheung CW, Yang LQ, Yu WF. Increased renal clearance of rocuronium compensates for chronic loss of bile excretion, via upregulation of oatp2. Sci Rep. 2017;7:40438.
doi: 10.1038/srep40438
pubmed: 28084414
pmcid: 5233986
Miah MK, Shaik IH, Bickel U, Mehvar R. Effects of Pringle maneuver and partial hepatectomy on the pharmacokinetics and blood–brain barrier permeability of sodium fluorescein in rats. Brain Res. 2015;1618:249–60.
doi: 10.1016/j.brainres.2015.05.038
pubmed: 26051428
Wierda JM, Proost JH. Structure-pharmacodynamic-pharmacokinetic relationships of steroidal neuromuscular blocking agents. Eur J Anaesthesiol Suppl. 1995;11:45–54.
pubmed: 8557006
Roy JJ, Varin F. Physicochemical properties of neuromuscular blocking agents and their impact on the pharmacokinetic–pharmacodynamic relationship. Br J Anaesth. 2004;93:241–8.
doi: 10.1093/bja/aeh181
pubmed: 15169739
Ezzine S, Yamaguchi N, Varin F. Determination of interstitial rocuronium concentrations in the muscle tissue of anesthetized dogs by microdialysis. J Pharmacol Toxicol Methods. 2004;49:121–9.
doi: 10.1016/j.vascn.2003.08.004
pubmed: 14990337
Tralhao JG, Hoti E, Oliveiros B, Abrantes AM, Botelho MF, Castro-Sousa F. Intermittent pringle maneuver and hepatic function: perioperative monitoring by noninvasive ICG-clearance. World J Surg. 2009;33:2627–34.
doi: 10.1007/s00268-009-0204-2
pubmed: 19760319
Isozaki H, Adam R, Gigou M, Szekely AM, Shen M, Bismuth H. Experimental study of the protective effect of intermittent hepatic pedicle clamping in the rat. Br J Surg. 1992;79:310–3.
doi: 10.1002/bjs.1800790409
pubmed: 1576495
De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with doppler sonography. AJR Am J Roentgenol. 1995;165:1151–5.
doi: 10.2214/ajr.165.5.7572494
pubmed: 7572494