JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2021, Vol. 41 ›› Issue (6): 761-763.doi: 10.3969/j.issn.1674-8115.2021.06.009

• Clinical research • Previous Articles     Next Articles

Pharmacodynamics of cisatracurium intravenously infused in infants and young children undergoing living donor liver transplantation

Wen YIN(), Teng WANG(), Yu-xi ZHOU, Yan-nan HANG, Da-xiang WEN()   

  1. Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2021-06-28 Published:2021-06-29
  • Contact: Teng WANG,Da-xiang WEN;;
  • Supported by:
    National Natural Science Foundation of China(81771236)

Abstract: Objective

·To observe pharmacodynamics of cisatracurium intravenously infused in infants and young children with end-stage liver disease during living donor liver transplantation.


·Sixteen patients of American Society of Anesthesiologists (ASA) physical status Ⅲ and Ⅳ, aged 6-24 months, with end-stage liver disease, undergoing liver transplantation were studied. Neuromuscular transmission was monitored by the responses of the adductor pollicis to train-of-four (TOF) stimulation of ulnar nerve, using the accelerography (TOF-Watch). Endotracheal intubation was performed after intravenous injection of 0.15 mg/kg cisatracurium, with T1 being the maximum inhibitory degree. After recovery of T1 to 3%, cisatracurium was infused at an initial rate of 2 μg/(kg·min). The infusion rate was adjusted to maintain a constant 90% to 95% neuromuscular paralysis until the end of the operation. The onset time, no reaction period of TOF, the dosage of cisatracurium given during paleo-phepatic phase, an-hepatic phase and neo-hepatic phase, the time to 25% recovery of T1, recovery index (25%?75%), and the time for the TOF ratio (TOFr) to reach 0.9 were recorded respectively.


·The infusion rate was (1.37±0.46) μg/(kg·min). The average infusion rate of drugs in the three different periods showed a downward trend, but there was no statistical difference (P=0.110). The onset time of cisatracurium was (242.63±46.74) s. The no reaction period of TOF was (34.02±7.71) min. Following termination of the infusion, the time to 25% recovery of T1 was (12.80±3.49) min, and the recovery index (25%?75%) was (15.12±4.59) min. The time of TOFr=0.9 was (40.27±7.03) min.


·The pharmacodynamical characteristics of muscle relaxants should be fully understood during living donor liver transplantation in infants and young children with end-liver disease. When cisatracurium (0.15 mg/kg) is used for anesthesia induction, endotracheal intubation should be performed 4 min after administration. In the maintenance stage of anesthesia, the infusion dose requirement of cisatracurium is basically unchanged in the three different periods,and the infusion rate of 1.4 μg/(kg·min) can provide satisfactory muscle relaxation effect.

Key words: liver transplantation, infants and young children, cisatracurium, pharmacodynamics

CLC Number: