Pharmacokinetics and pharmacodynamics of rocuronium in patients with cirrhosis.


BACKGROUND:Rocuronium, like other steroidal nondepolarizing muscle relaxants, may in part be eliminated by the liver. To determine the influence of liver disease on its neuromuscular blocking effect, we studied the pharmacokinetics and pharmacodynamics of rocuronium in patients with cirrhosis. METHODS:Eighteen patients undergoing elective surgery, 10 with cirrhosis and 8 with normal liver function, were studied. Anesthesia was induced with intravenous thiopental 5-7 and maintained with 60% nitrous oxide in oxygen and repeated doses of fentanyl 2 The force of thumb adduction in response to supramaximal ulnar nerve stimulation was monitored and recorded. An intravenous bolus of rocuronium 0.6 was administered and venous blood sampled at frequent intervals for 6 h. Plasma concentrations of rocuronium was measured by high-pressure liquid chromatography. Data were fitted to both a pharmacokinetic and a pharmacodynamic model by using a two-compartment open model and an effect compartment model. Data were analyzed by least-squares regression. RESULTS:The onset of neuromuscular blockade was longer (P < 0.01) in patients with cirrhosis (158 +/- 56 s) than in normal patients (108 +/- 33 s). Recovery of the thumb twitch to 75 and 90% of its control value was 77 +/- 25 and 88 +/- 29 min in cirrhotic patients versus 57 +/- 11 and 64 +/- 13 min, respectively, in normal patients (P < 0.05). The central volume of distribution of rocuronium was 104 +/- 21 in cirrhotic patients and 78 +/- 24 in normal patients (P < 0.05). No significant difference in elimination kinetics was observed between the two groups. The elimination half-life was 87.5 +/- 17.5 min in normal patients and 96.0 +/- 36.8 min in cirrhotic patients (difference not significant). This increased onset time was linearly correlated to the increased central volume of distribution of rocuronium in cirrhosis. CONCLUSION:Rocuronium onset time is longer in cirrhotic patients than in those with normal liver function; this can be explained by an increase in the volume in which rocuronium initially distributes. Although elimination kinetics are unchanged in patients with cirrhosis, rocuronium recovery time is prolonged in cirrhotic patients.






Khalil M,D'Honneur G,Duvaldestin P,Slavov V,De Hys C,Gomeni R




Has Abstract


1994-06-01 00:00:00












  • Alveolar-to-arterial-to-venous anesthetic partial pressure differences in humans.

    abstract::To determine the correlation between the partial pressures of anesthetics in venous and arterial blood (Pv and Pa), and to assess whether this correlation was better than that between the partial pressure of anesthetic in alveolar gas (PA) and Pa, isoflurane (n = 4) or halothane (n = 4) was administered to eight patie...


    pub_type: 杂志文章


    authors: Carpenter RL,Eger EI 2nd

    更新日期:1989-04-01 00:00:00

  • Fibromyalgia survey criteria are associated with increased postoperative opioid consumption in women undergoing hysterectomy.

    abstract:BACKGROUND:The current study was designed to test the hypothesis that the fibromyalgia survey criteria would be directly associated with increased opioid consumption after hysterectomy even when accounting for other factors previously described as being predictive for acute postoperative pain. METHODS:Two hundred eigh...


    pub_type: 杂志文章


    authors: Janda AM,As-Sanie S,Rajala B,Tsodikov A,Moser SE,Clauw DJ,Brummett CM

    更新日期:2015-05-01 00:00:00

  • Differential effects of etomidate and midazolam on vascular adenosine triphosphate-sensitive potassium channels: isometric tension and patch clamp studies.

    abstract:BACKGROUND:The aim of this study was to investigate the effects of two imidazoline-derived intravenous anesthetics, etomidate and midazolam, on vascular adenosine triphosphate-sensitive potassium (KATP) channel activity. METHODS:In isolated rat aorta, isometric tension was recorded to examine the anesthetic effects on...


    pub_type: 杂志文章


    authors: Nakamura A,Kawahito S,Kawano T,Nazari H,Takahashi A,Kitahata H,Nakaya Y,Oshita S

    更新日期:2007-03-01 00:00:00

  • Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery.

    abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:Cardiac surgery is associated with cognitive decline and postoperative delirium. The relationship between postoperative delirium and cognitive decline after cardiac surgery is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW:The development of postoperative delirium is associated wi...


    pub_type: 杂志文章


    authors: Brown CH 4th,Probert J,Healy R,Parish M,Nomura Y,Yamaguchi A,Tian J,Zehr K,Mandal K,Kamath V,Neufeld KJ,Hogue CW

    更新日期:2018-09-01 00:00:00

  • Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery.

    abstract:BACKGROUND:Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model...


    pub_type: 杂志文章


    authors: Sonny A,Kurz A,Skolaris LA,Boehm L,Reynolds A,Cummings KC 3rd,Makarova N,Yang D,Sessler DI

    更新日期:2020-01-01 00:00:00

  • Estimating anesthesia and surgical procedure times from medicare anesthesia claims.

    abstract:BACKGROUND:Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart...


    pub_type: 杂志文章


    authors: Silber JH,Rosenbaum PR,Zhang X,Even-Shoshan O

    更新日期:2007-02-01 00:00:00

  • Effects of intrathecally administered lamotrigine, a glutamate release inhibitor, on short- and long-term models of hyperalgesia in rats.

    abstract:BACKGROUND:Lamotrigine is a sodium channel blocker that inhibits the neuronal release of glutamate. Systemic administration of lamotrigine induces analgesia in short- and long-term models of hyperalgesia in rats. Considering the key role of N-methyl-D-aspartate receptors in the sensitization of dorsal horn neurons that...


    pub_type: 杂志文章


    authors: Klamt JG

    更新日期:1998-02-01 00:00:00

  • A comparison of the cerebral protective effects of isoflurane and barbiturates during temporary focal ischemia in primates.

    abstract::Isoflurane has protective properties during experimental global brain ischemia or hypoxia. However, this has not been evaluated in the more common case of focal ischemia, e.g., as caused by middle cerebral artery occlusion (MCAO). The authors therefore compared the effects of isoflurane, thiopental, and N2O/fentanyl a...


    pub_type: 杂志文章


    authors: Nehls DG,Todd MM,Spetzler RF,Drummond JC,Thompson RA,Johnson PC

    更新日期:1987-04-01 00:00:00

  • Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.

    abstract:BACKGROUND:Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating...


    pub_type: 杂志文章


    authors: Dexter F,Blake JT,Penning DH,Sloan B,Chung P,Lubarsky DA

    更新日期:2002-03-01 00:00:00

  • Opioid facilitation of rewarding electrical brain stimulation is suppressed in rats with neuropathic pain.

    abstract:INTRODUCTION:Opioids are powerful analgesics, but are also common drugs of abuse. Few studies have examined how neuropathic pain alters the pharmacology of opioids in modulating limbic pathways that underlie abuse liability. METHODS:Rats with or without spinal nerve ligation (SNL) were implanted with electrodes into t...


    pub_type: 杂志文章


    authors: Ewan EE,Martin TJ

    更新日期:2011-03-01 00:00:00

  • Exaggerated anesthetic requirements in the preferentially anesthetized brain.

    abstract:BACKGROUND:The brain is assumed to be the site of anesthetic action, but anesthetics have effects elsewhere, such as the spinal cord. A preferentially anesthetized goat brain model was used to determine the importance of anesthetic action in the brain. METHODS:Six goats were anesthetized with isoflurane; after trachea...


    pub_type: 杂志文章


    authors: Antognini JF,Schwartz K

    更新日期:1993-12-01 00:00:00

  • Malignant hyperthermia phenotype: hypotension induced by succinylcholine in susceptible swine.

    abstract:BACKGROUND:Succinylcholine causes immediate and severe arterial hypotension in swine with the malignant hyperthermia phenotype. The underlying mechanisms are unknown. METHODS:Malignant hyperthermia-susceptible (MHS; n = 10) and normal swine (n = 5) were anesthetized with thiopental. The following were monitored: elect...


    pub_type: 杂志文章


    authors: Sigg DC,Iaizzo PA

    更新日期:2000-06-01 00:00:00

  • Days Alive and Out of Hospital: Validation of a Patient-centered Outcome for Perioperative Medicine.

    abstract:BACKGROUND:Days alive and out of hospital is a potentially useful patient-centered quality measure for perioperative care in adult surgical patients. However, there has been very limited prior validation of this endpoint with respect to its ability to capture differences in patient-level risk factor profiles and longer...


    pub_type: 杂志文章


    authors: Jerath A,Austin PC,Wijeysundera DN

    更新日期:2019-07-01 00:00:00

  • Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study.

    abstract:BACKGROUND:Preoperative anemia is frequent in patients undergoing orthopedic surgery. The purpose of this study was to assess the preoperative increase of hemoglobin in iron deficiency anemia patients treated with intravenous iron. METHODS:After obtaining written informed consent, 20 patients with iron deficiency anem...


    pub_type: 杂志文章


    authors: Theusinger OM,Leyvraz PF,Schanz U,Seifert B,Spahn DR

    更新日期:2007-12-01 00:00:00

  • The effects of halothane on voltage-dependent calcium channels in isolated Langendorff-perfused rat heart.

    abstract:BACKGROUND:Halothane has been previously shown in vitro to decrease both the inward calcium current in isolated cells and the density of calcium antagonist binding sites in cardiac sarcolemmal membranes prepared from several species, including humans, presumably contributing to the negative inotropic effects seen with ...


    pub_type: 杂志文章


    authors: Lee DL,Zhang J,Blanck TJ

    更新日期:1994-11-01 00:00:00

  • Midazolam: effects on amnesia and anxiety in children.

    abstract:BACKGROUND:The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administrat...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kain ZN,Hofstadter MB,Mayes LC,Krivutza DM,Alexander G,Wang SM,Reznick JS

    更新日期:2000-09-01 00:00:00

  • Magnesium--essentials for anesthesiologists.

    abstract::Magnesium plays a fundamental role in many cellular functions, and thus there is increasing interest in its role in clinical medicine. Although numerous experimental studies indicate positive effects of magnesium in a variety of disease states, large clinical trials often give conflicting results. However, there is cl...


    pub_type: 杂志文章,评审


    authors: Herroeder S,Schönherr ME,De Hert SG,Hollmann MW

    更新日期:2011-04-01 00:00:00

  • Higher frequency ventilation attenuates lung injury during high-frequency oscillatory ventilation in sheep models of acute respiratory distress syndrome.

    abstract:BACKGROUND:High-frequency oscillatory ventilation (HFOV) at higher frequencies minimizes the tidal volume. However, whether increased frequencies during HFOV can reduce ventilator-induced lung injury remains unknown. METHODS:After the induction of acute respiratory distress syndrome in the model by repeated lavages, 2...


    pub_type: 杂志文章


    authors: Liu S,Yi Y,Wang M,Chen Q,Huang Y,Liu L,Xie J,Zhou D,Qiu H

    更新日期:2013-08-01 00:00:00

  • Site of hemodynamic effects of intrathecal alpha 2-adrenergic agonists.

    abstract::Intrathecally administered alpha 2-adrenergic agonists produce analgesia in humans but may also produce hypotension and bradycardia. To further characterize hemodynamic depression produced by intrathecally administered alpha 2-adrenergic agonists, clonidine (100-1,500 micrograms) was injected into the cervical, thorac...


    pub_type: 杂志文章


    authors: Eisenach JC,Tong CY

    更新日期:1991-04-01 00:00:00

  • Anterior shift of the dominant EEG rhytham during anesthesia in the Java monkey: correlation with anesthetic potency.

    abstract::EEG amplitude dominance in awake man is posterior. During EEG monitoring in patients, the authors observed the abrupt appearance of anterior amplitude dominance during induction of anesthesia with halothane, enflurane, or thiopental. This EEG change is coincident with loss of eyelid reflex and loss of ability to respo...


    pub_type: 杂志文章


    authors: Tinker JH,Sharbrough FW,Michenfelder JD

    更新日期:1977-04-01 00:00:00

  • Effects of volatile anesthetics on sarcolemmal calcium transport and sarcoplasmic reticulum calcium content in isolated myocytes.

    abstract:BACKGROUND:The surface membrane Ca(2+)-adenosine triphosphatase and Na(+)-Ca(2+) exchanger transport Ca(2+) out of the ventricular myocyte, competing for cytosolic Ca(2+) with the Ca(2+)-adenosine triphosphatase located in the sarcoplasmic reticulum. In this study the authors examined the effects of halothane, isoflura...


    pub_type: 杂志文章


    authors: Hannon JD,Cody MJ

    更新日期:2002-06-01 00:00:00

  • Isoflurane neuroprotection in hypoxic hippocampal slice cultures involves increases in intracellular Ca2+ and mitogen-activated protein kinases.

    abstract:BACKGROUND:The volatile anesthetic isoflurane reduces acute and delayed neuron death in vitro models of brain ischemia, an action that the authors hypothesize is related to moderate increases in intracellular calcium concentration ([Ca2+]i). Specifically, the authors propose that during hypoxia, moderate increases in [...


    pub_type: 杂志文章


    authors: Gray JJ,Bickler PE,Fahlman CS,Zhan X,Schuyler JA

    更新日期:2005-03-01 00:00:00

  • Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury.

    abstract:BACKGROUND:Patients with brain injury are at high risk of extubation failure. METHODS:We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with brain injury. RESULT...


    pub_type: 杂志文章,多中心研究


    authors: Asehnoune K,Seguin P,Lasocki S,Roquilly A,Delater A,Gros A,Denou F,Mahé PJ,Nesseler N,Demeure-Dit-Latte D,Launey Y,Lakhal K,Rozec B,Mallédant Y,Sébille V,Jaber S,Le Thuaut A,Feuillet F,Cinotti R,ATLANREA group.

    更新日期:2017-08-01 00:00:00

  • Gabapentin suppresses cutaneous hyperalgesia following heat-capsaicin sensitization.

    abstract:BACKGROUND:The anticonvulsant gabapentin, proven effective for neuropathic pain in two large, placebo-controlled clinical trials, is widely used for treatment of chronic pain. Preclinical studies have demonstrated analgesic and antiallodynic effects in models involving neuronal sensitization and nerve injury, without a...


    pub_type: 杂志文章


    authors: Dirks J,Petersen KL,Rowbotham MC,Dahl JB

    更新日期:2002-07-01 00:00:00

  • Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.

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    pub_type: 临床试验,杂志文章,随机对照试验


    authors: McCartney CJ,Brull R,Chan VW,Katz J,Abbas S,Graham B,Nova H,Rawson R,Anastakis DJ,von Schroeder H

    更新日期:2004-08-01 00:00:00

  • Autologous platelet-rich plasma does not reduce transfusion of homologous blood products in patients undergoing repeat valvular surgery.

    abstract:BACKGROUND:Patients undergoing cardiac surgery employing cardiopulmonary bypass frequently require transfusion of homologous blood products and, therefore, are exposed to the risk of transfusions. Autologous platelet-rich plasma administration may reduce homologous transfusion and attendant risks. METHODS:In a blinded...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Ereth MH,Oliver WC Jr,Beynen FM,Mullany CJ,Orszulak TA,Santrach PJ,Ilstrup DM,Weaver AL,Williamson KR

    更新日期:1993-09-01 00:00:00

  • Prospective external validation of a predictive score for postoperative pulmonary complications.

    abstract:BACKGROUND:No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for posto...


    pub_type: 杂志文章,多中心研究


    authors: Mazo V,Sabaté S,Canet J,Gallart L,de Abreu MG,Belda J,Langeron O,Hoeft A,Pelosi P

    更新日期:2014-08-01 00:00:00

  • Vaporized perfluorocarbon improves oxygenation and pulmonary function in an ovine model of acute respiratory distress syndrome.

    abstract:BACKGROUND:Perfluorocarbon liquids are being used experimentally and in clinical trials for the treatment of acute lung injury. Their resemblance to inhaled anesthetic agents suggests the possibility of application by vaporization. The authors' aim was to develop the technical means for perfluorocarbon vaporization and...


    pub_type: 杂志文章


    authors: Bleyl JU,Ragaller M,Tschö U,Regner M,Kanzow M,Hübler M,Rasche S,Albrecht M

    更新日期:1999-08-01 00:00:00

  • A comparison of methods of blood withdrawal and sample preparation for potassium measurements.

    abstract::The effect on measured potassium values of a number of factors involved in sample acquisition and preparation were investigated. Measured potassium values in either plasma or serum were not influenced by the site of sample withdrawal, the presence of a tourniquet, or the time elapsed between blood sampling and analysi...


    pub_type: 杂志文章


    authors: Hill AB,Nahrwold ML,Noonan D,Northrop P

    更新日期:1980-07-01 00:00:00

  • Hemodilution with oxyhemoglobin. Mechanism of oxygen delivery and its superaugmentation with a nitric oxide donor (sodium nitroprusside).

    abstract:BACKGROUND:Hemodilution (HD) with oxyhemoglobin colloid (oxyHb) provides a greater arterial oxygen content (CaO2) than HD with conventional colloids; however, oxygen delivery (DO2) is essentially the same, because, in contrast to conventional HD, cardiac output (CO) is not augmented. This study seeks to elucidate the m...


    pub_type: 杂志文章


    authors: Rooney MW,Hirsch LJ,Mathru M

    更新日期:1993-07-01 00:00:00