The pharmacokinetics and pharmacodynamics of rocuronium in patients with hepatic cirrhosis

Abstract

Aims To determine the effects of hepatic cirrhosis on the pharmacodynamics and pharmacokinetics of rocuronium bromide. Methods We studied 21 healthy patients and 17 patients with mild or moderate cirrhosis (Child-Pugh Class A and B). Patients were premedicated with diazepam orally; anaesthesia was induced with fentanyl and thiopentone, and maintained with isoflurane 0.6% (end-tidal) and nitrous oxide 66% in oxygen. The compound action potential of the adductor pollicis muscle in response to supramaximal stimulation of the ulnar nerve was recorded using the train-of-four (TOF) twitch technique. A bolus dose of rocuronium 0.6 mg kg −1 was then given. Venous blood samples were taken for up to 8 h, and plasma rocuronium concentrations determined by h.p. Keywords: hepatic cirrhosis, neuromuscular block, rocuronium (Child's class B), and eight healthy patients, Khalil and Introduction colleagues [6] found that the onset of neuromuscular block was slower in cirrhotic than in healthy patients (158 s vs Rocuronium bromide is an aminosteroid non-depolarizing neuromuscular blocking agent with a more rapid onset of 108 s), and that recovery of twitch height (T 1 5T 0 ) to 75% and 90% was prolonged. The plasma concentrations of action than other currently available non-depolarizing drugs, but a duration of action comparable with vecuronium [1].rocuronium were more variable in the cirrhotic patients, and pharmacokinetic analysis showed that the central volume The other aminosteroid non-depolarizing neuromuscular blocking drugs, pancuronium and vecuronium, have been of distribution and mean residence time were greater in the cirrhotic. Although the mean clearance was lower in the shown to have a prolonged effect and an increased elimination half-life in hepatic cirrhosis [2,3]. Rocuronium, cirrhotic group (2.41 vs 2.79 ml kg −1 min −1 ), this did not achieve statistical significance. More recently, Magorian and like vecuronium, is a monoquaternary cation and might be expected to undergo considerable biliary excretion [4], and colleagues studied a group of 10 patients with liver dysfunction of diverse aetiology and compared them with this has been directly suggested by work in the cat [5].There have been two previous studies of the pharmaco-10 healthy patients studied previously [7]. They found no difference in either time to onset of block or recovery of dynamics and pharmacokinetics of rocuronium in cirrhosis, with conflicting findings. In a study of 10 cirrhotic patients twitch height (T 1 5T 0 ) to 25% (clinical duration). They applied a population approach to pharmacokinetic analysis, and found an increase in initial volume of distribution (V 1 ), and also an increase in the peripheral compartments (V 2 and

Dexamethasone Does Not Inhibit Sugammadex Reversal After Rocuronium-Induced Neuromuscular Block

“…12 Although we did not measure rocuronium and dexamethasone plasma concentrations, they were likely less concentrated than sugammadex plasma concentrations based on the doses used and their respective pharmacokinetic characteristics. 13,14 Nonetheless, it is important to point out that a proper comparison with previous finding in vitro is difficult, given that in vitro concentrations are likely more comparable with tissue concentrations rather than plasma concentrations.…”

Anesthesiologist's satisfaction using between cisatracurium and rocuronium for the intubation in the anesthesia induced by remifentanil and propofol

“…However, because rocuronium was mostly metabolized in the liver and excreted through bile [4], the duration of neuromuscular blockade of rocuronium may be prolonged in patients with liver and kidney failure [5,6]. …”

Effects on Intubating Conditions of Pretreatment with Remifentanil before Administration of Cisatracurium

“…However, animal studies have suggested that rocuronium is mostly metabolized in the liver and excreted through bile, and less than 10% of the unchanged form after a bolus administration is detected in cat urine in 24 hours 23. The duration of neuromuscular blockade of rocuronium at an equipotent single dose may be prolonged and variable in patients with liver and kidney failure 24,25. In this respect, cisatracurium is metabolized by Hoffmann elimination to laudanosine and is recommendable in patients with liver and kidney failure.…”