Impact of liver function on muscle-relaxant effect of cisatracurium in patients with hepatitis B cirrhosis

Abstract

Objective To investigate the impact of liver function on muscle-relaxant effect of cisatracurium in the anesthesia induction in patients with hepatitis B cirrhosis. Methods Clinical data of 55 patients with hepatitis B cirrhosis who received upper abdomen surgery under general anesthesia from April 2011 to February 2013 in Department of Anesthesiology, the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. According to liver function Child-Pugh grade, the patients were divided into two groups: grade-A group [n=32; 19 males, 13 females; (43±8) years old], grade-B group [n=23; 12 males,11 females; (45±8) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Anesthesia was induced with intravenous midazolam (0.05 mg/kg), propofol (1.5 mg/kg), fentanyl (4 μg/kg) and cisatracurium (0.15 mg/kg) in patients of two groups. The muscle-relaxant effect in patients of two groups after use of cisatracurium, including the onset time of muscle relaxation, period of no-response to train-of-four stimulation (TOF), recovery time of 25%TOF, 50%TOF,75%TOF, and muscle relaxation recovery indexes were recorded by accelerating muscle relaxation monitor TOF-Watch SX, and the tracheal intubation condition was assessed. The measurement data were compared by t test and enumeration data were compared by Chi-square test. Results The tracheal intubation condition in patients of two groups were both excellent or good and no significant difference was observed between two groups (χ2=0.15; P>0.05). Compared with grade-B group, the onset time of muscle relaxation, period of no-response to TOF, recovery time of 25%TOF, 50%TOF, 75%TOF were shorter in grade-A group, whose muscle relaxation recovery indexes was lower. But there was no significant difference(t=1.24, 1.04, 0.97, 1.96, 1.41, 1.34; P>0.05). Conclusions The tracheal intubation condition and muscle-relaxant effect are not affected by liver function Child-Pugh grade when cisatracurium is administered in patients with hepatitis B cirrhosis of Child-Pugh grade-A or B. There is no need to adjust the dose when cisatracurium is used in clinic. Key words: Atracurium; Drug utilization; Liver cirrhosis; Anesthetics, general