Comparison of neuromuscular blocking effects of rocuronium given by different methods of administration during liver transplantation

：Objective To compare theneuromuscular blocking effects of rocuronium given by intermittent bolus injection,continuous infusion and target-controlled infusion during liver transplantation. MethodsThirty-six patients with hepatic failure of both sexes aged 21-63 yr weighing 48-80 kgundergoing liver transplantation were studied. The donor livers were obtained from livingdonors. The patients were divided into 3 groups according to the mode of rocuroniumadministration ( n = 12 each): group Ⅰintermittentbolus injection (group Ⅳ); group Ⅱ continuous infusion (group CI) and group Ⅲ target-controlled infusion (group TCI). Neuromuscular block was assessed by TOFstimulation of ulnar nerve (TOF-Watch SX). Anesthesia was induced with midazolam 5mg,fentanyl 4-6 μg/kg and propofol 1.0-1.5 mg/kg, androcuronium was administered using different modes of administration. A bolus of rocuronium0.6 mg/kg was given during induction and supplemental rocuronium 0.15 mg/kg was given whenT1 was returned to 25% in preanhepatic stage and T4/T1 (TOFR) returned to 25% in anhepaticand neohepatic stages in group Ⅳ. TCI at an initial target effect-siteconcentration of 3 μg/ml was started during induction, theconcentration was adjusted to maintain T1 at 5%-10% , TCI was temporarily suspended at thebeginning of anhepatic and neohepatic stages, and then TCI at a target effect-siteconcentration of 0.1 μg/ml was started again and theconcentration was adjusted to maintain T1 at 5%-10% in group TCI. A bolus of rocuronium0.6 mg/kg was given during induction, the initial infusion rate was set at 30 μg·kg-1 ·min-1 and then adjusted to maintain T1 at 5%-10% in preanhepatic stage, CIwas temporarily suspended at the beginning of anhepatic and neohepatic stages, and then itwas started again at 1 μg· kg-1 · min-1 inpreanhepatic stage and the infusion rate was adjusted to maintain T1 at 5%-10% in groupCI. Tracheal intubation was performed when the maximal effect was achieved. Theadministration was stopped after suture of the peritoneum. The onset time, the maximaldepression of T1 , intubation condition, recovery time and the total amount of rocuroniumconsumed were recorded.Results There was no significant difference in onset time, themaximal depression of T1, intubation condition,ecovery time and the total amount ofrocuronium consumed among the 3 groups ( P ＞0.05).Conclusion There is no significant difference in the onset and recovery when neuromuscularblocade was induced by rocuronium via Ⅳ, CI and TCI, butneuromuscular blockade induced by rocuronium via TCI and CI is more stable than thatinduced by rocuronium via Ⅳ during liver transplantation. Key words: Androstanols; Injections,intravenous; Infusions, intravenous; Drug delivery systems; Neuromuscular blockade; Livertransplantation