Atracurium and severe hepatic disease: a case report

Gyasi, Henry K.; Naguib, Mohamed

doi:10.1007/bf03010043

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…Resistance to several non‐depolarizing neuromuscular blocking agents, including atracurium, has been reported in people with liver disease (Dundee & Gray 1953; Bell et al. 1985; Gyasi & Naguib 1985). Atracurium species bind to globulin in plasma (Gyasi & Naguib 1985), hence the hyperglobulinaemia often seen in chronic liver disease (Kerr 1991) may lead to sequestration of cis ‐atracurium, reducing availability of the drug at the neuromuscular junction.…”

Section: Discussionmentioning

confidence: 99%

“…1985; Gyasi & Naguib 1985). Atracurium species bind to globulin in plasma (Gyasi & Naguib 1985), hence the hyperglobulinaemia often seen in chronic liver disease (Kerr 1991) may lead to sequestration of cis ‐atracurium, reducing availability of the drug at the neuromuscular junction. Nevertheless, this patient had normal plasma globulin concentration (29 g L −1 ), eliminating this as a possible cause of its reduced sensitivity to cis ‐atracurium.…”

Section: Discussionmentioning

confidence: 99%

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cis-Atracurium in dogs with and without porto-systemic shunts

Adams

Senior

Jones

et al. 2006

Veterinary Anaesthesia and Analgesia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

cis-Atracurium in dogs with and without porto-systemic shunts

Adams

Senior

Jones

et al. 2006

Veterinary Anaesthesia and Analgesia

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“…[7] Metabolism of atracurium and cis-atracurium are unaffected by liver disease because it is broken down spontaneously by Hofmann degradation. [8] However, it is important to monitor the degree of relaxation because patients with liver disease show increased resistance to drug and shorter duration of action. Prolonged neuromuscular blockade can be reduced by decreasing the amount and frequency of neuromuscular blocking drugs.…”

Section: Discussion:-mentioning

confidence: 99%

Hepatic Resection: a Challenge to Anaesthesiologist!!!

Arora¹,

Chhaya²,

Parikh.³

2017

IJAR

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“…The non-cumulative properties of atracurium has been substantiated in several studies 3-5 and even in patients with renal or hepatic disease, the effect of atracurium has not been found to be cumulative . [4][5][6] However, it is of interest that our patient was receiving tamoxifen, which is an antiestrogenic drug and that the patient reported by BizzarriSchmid and Desai I was receiving danazol. Tamoxifen acts by competing with estrogen in target tissues whereas danazoi decreases ovarian estrogen production by inhibiting the output of pituitary gonadotxopins.…”

Section: Antiestrogenic Drugs and Atracurium -A Possible Interaction ?mentioning

confidence: 99%

Antiestrogenic drugs and atracurium - a possible interaction?

Naguib

Gyasi

1986

Can Anaesth Soc J

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We read with interest the case report of BizzarriSchmid and Desai describing a case of prolonged neuromuscular blockade with atracurium, t We have had a similar experience which we think is worth reporting.A 67-year-old female patient weighing 57kg was scheduled to undergo mastectomy for carcinoma of the breast. Preoperatively, she had hypertension which was controlled by oral methyldopa 250 mg and hydrochlorothiazide 25 mg, twice daily and triamterene 50rag. She was also receiving tamoxifen (an antiestrogen) 10mg orally twice daily as palliative treatment for breast cancer. Preoperative investigations including haemoglobin, serum electrolytes, BUN, liver function tests, ECG, chest x-ray and lung function tests were normal. She was premedicated with 10 mg diazepare orally 90 minutes preoperatively.Blood pressure was monitored every five minutes and the ECG, nasopharyngeal temperature and end-tidal CO2 were monitored continuously. Neuromuscular activity was monitored by recording the response of the adductor pollicis to supramaximal stimulation of the ulnar nerve using a Myotest peripheral nerve stimulator and a neeuromuscular function analyzer (Myograph 2000, Biometer). Four square wave impulses of 0.2 ms duration and 2 Hz frequency repeated every ten seconds (TOF) were employed.After induction of anaesthesia with phenoperidine 2 mg and thiopentone 300 mg, atracurium 28.5 mg (0.5 mg.kg-t) was administered and the trachea was intubated following complete suppression of the twitch response. This occurred after 145 seconds. Anaesthesia was maintained with 70 per cent nitrous oxide in oxygen and 0.5 mg phenoperidine doses, as required. The nasopharyngeal temperature remained above 36~ and the lungs were ventilated to maintain normocapnoia. Apart from a brief period of hypotension following induction, the cardiovascular system remained stable throughout surgery.It took 86 minutes for the first twitch of the TOF to reappear after the initial dose of atracurium. The expected time for retum is 36.9 ---8.6 minutes.2 No further doses of atracurium were given. Surgery lasted for 140 minutes and the TOF ratio at this stage was 0.33. The residual neuromuscular block was reversed with neostigmine 2.85 mg and atropine 1.4mg. Reversal was rapid and after 85 seconds the TOF ratio had reached 0.7. The patient was extubated and sent to the recovery room. Further recovery was uneventful.The explanation of Bizzarri-Schmid and Desai I that the prolonged recovery from the effects of the atracurium in their patient was due to cumulation of the drug is unlikely. The non-cumulative properties of atracurium has been substantiated in several studies 3-5 and even in patients with renal or hepatic disease, the effect of atracurium has not been found to be cumulative . [4][5][6] However, it is of interest that our patient was receiving tamoxifen, which is an antiestrogenic drug and that the patient reported by BizzarriSchmid and Desai I was receiving danazol. Tamoxifen acts by competing with estrogen in target tissues whereas danazoi decrease...

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Atracurium and severe hepatic disease: a case report

Abstract: Atracurium is a new non-depolarising

Cited by 13 publications

References 11 publications

cis-Atracurium in dogs with and without porto-systemic shunts

cis-Atracurium in dogs with and without porto-systemic shunts

Hepatic Resection: a Challenge to Anaesthesiologist!!!

Antiestrogenic drugs and atracurium - a possible interaction?

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