Changes in duration of action of rocuronium following decrease in hepatic blood flow during pneumoperitoneum for laparoscopic gynaecological surgeryReport as inadecuate




Changes in duration of action of rocuronium following decrease in hepatic blood flow during pneumoperitoneum for laparoscopic gynaecological surgery - Download this document for free, or read online. Document in PDF available to download.

BMC Anesthesiology

, 17:45

General pharmacology and pharmacokinetics

Abstract

BackgroundA moderate insufflation pressure and deep neuromuscular blockade NMB have been recommended in laparoscopic surgery in consideration of the possible reduction in splanchnic perfusion due to the CO2-pneumoperitoneum. Since the liver is the major organ for rocuronium metabolism, the question of whether NMB of rocuronium would change with the variation of liver perfusion during pneumoperitoneum during laparoscopic surgery merits investigation.

MethodsIn this prospective study, a total of sixty female patients scheduled for either selective laparoscopic gynaecological surgery group laparoscopy or laparotomy for gynaecological surgery group control were analyzed. Rocuronium was administered with closed-loop feedback infusion system, which was also applied to monitor NMB complied with good clinical research practice GCRP. The onset time, clinical duration, and recovery index were measured. Hepatic blood flow was assessed by laparoscopic intraoperative ultrasonography before insufflation-after entering the abdominal cavity T1, 5 min after insufflation in the Trendelenburg position-5 min after skin incision T2, 15 min after insufflation in the Trendelenburg position-15 min after skin incision T3, 30 min after insufflation in the Trendelenburg position-30 min after skin incision T4, and 5 min after deflation-before closing the abdomen T5 in group laparoscopy-group control respectively. The relationship between the clinical duration of rocuronium and portal venous blood flow was analyzed using linear or quadratic regression.

ResultThe clinical duration and RI of rocuronium were both prolonged significantly in group laparoscopy 36.8 ± 8.3 min; 12.8 ± 5.5 min compared to group control 29.0 ± 5.8 min; 9.8 ± 4.0 min P < 0.0001; P = 0.018. A significant decrease was found in portal venous blood flow during the entire pneumoperitoneum period in group laparoscopy compared with group control P < 0.0001. There was a significant correlation between the clinical duration of rocuronium and portal venous blood flow Y = 51.800-0.043X + 1.86E-005 X; r = 0.491; P < 0.0001.

ConclusionRocuronium-induced NMB during laparoscopic gynaecological surgery might be prolonged due to the decrease in portal venous blood flow induced by CO2-pneumoperitoneum. Less rocuronium could be required to achieve a desirable NMB in laparoscopic gynaecological surgery.

Trial registrationChiCTR. Registry number: ChiCTR-OPN-15007524. Date of registration: December 4, 2015.

KeywordsRocuronium Hepatic blood flow Pneumoperitoneum AbbreviationsASAAmerican Society of Anesthesiologists

BFVBlood flow volume

BMIBody mass index

CLMRIS-IClosed-loop muscle relaxant injection system

GCRPGood clinical research practice

IAPIntra-abdominal pressure

LIOULaparoscopic intraoperative ultrasonography

MVMean flow velocity

NMBNeuromuscular blockade

NMBAsNeuromuscular blocking agents

PETCO2End- tidal carbon dioxide pressure

RIRecovery index

TCITarget-controlled infusion

TIVATotal intravenous anaesthesia

TOFTrain- of-four

VDVessel diameter

Electronic supplementary materialThe online version of this article doi:10.1186-s12871-017-0335-1 contains supplementary material, which is available to authorized users.

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Author: Yang Liu - Wen Cao - Yu Liu - Yun Wang - Ren Lang - Yun Yue - An-Shi Wu

Source: https://link.springer.com/







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