Liver Dysfunction
Conditions
Keywords
mivacurium chloramine, patients with liver cirrhosis, muscle relaxation effect
Brief summary
Observed the muscle relaxation of mivacurium in patients with liver cirrhosis.Clear of mivacurium in patients with liver cirrhosis without muscle relaxant accumulation and delayed recovery phenomenon
Detailed description
The liver is an important organ of the body to maintain life activities, material and energy metabolism, and the main organ of biotransformation and elimination of toxic substances and drugs, have many complex functions. Anesthetic drugs mostly through liver transformation and degradation.Liver cirrhosis, liver cancer patients due to abnormal liver dysfunction and liver metabolism, Most of the muscle relaxant prone to muscle relaxant accumulation and delayed recovery of patients with liver cirrhosis. Mivacurium is a new type of non depolarizing muscle relaxants，has the characteristics of rapid onset, short duration of action. Mivacurium can produce similar clinical effect of depolarizing muscle relaxant succinylcholine, and rapidly be blood Che catabolism, Without liver metabolism. It can either as a single vein for medicinal endotracheal intubation, or as maintain continuous intravenous auxiliary anesthesia drug , is a muscle relaxant to shorten the clinical anesthesia recovery period ideal.
Interventions
Anesthesia induction: Intravenous injection of midazolam 0.05 mg/kg,Etomidate 0.3 mg/kg,Sufentanil 0.5 g/kg,TOF detection and adjustment of the first twitch height (T1)100%, Mivacurium Chloramine 0.07 mg/kg intraveous injecting in 5 minutes. Anesthesia maintenance: Two groups of sevoflurance 1%\ 8% inhalation anesthesia plus intravenous infusion of remifentanil 0.05～0.2 µg/kg/min,Mivacurium Chloramine 6mg/kg/h, Appropriate supplementary analgesia dose of sufentanil before skin incision and the abdomen was closed. The two groups were maintained until the Bis value was 40 \ 60. PetCO2 was 30 \ 35mmHg. Hemodynamic fluctuations did not exceed 20% of the baseline value.At least 20 minutes before the operation stopping Mivacurium infusion,Before the end of operation 5-10 minutes stopping infusion of remifentanil and sevoflurane.
Sponsors
Jiangsu Nhwa Pharmaceutical Co., Ltd.
Tang-Du Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients volunteered for the clinical research and signed a written informed consent * Experimental group patients is cirrhosis of the liver (liver function grade Child - Pugh, grade A) ready to abdominal surgery patients; The control group was no cirrhosis, ready to abdominal surgery patients * Aged 18 \ 60 * BMI\<28kg/㎡ * The American society of anesthesiologists (ASA) class I \ II
Exclusion criteria
* Systolic blood pressure ≥180 mm Hg or \< 90 mm Hg, diastolic blood pressure ≥110 mm Hg or \< 60 mm Hg * Serious heart, brain, liver, kidney, lung, endocrine diseases or serious infection * Patients with difficult airway (such as Mallampati airway class III, airway abnormalities, etc.) * HR \< 50 times/min * The patient had a history of mental illness or chronic psychiatric drugs, chronic pain medication history * History of alcoholism * Patients with neuromuscular system disease * Has a tendency to malignant hyperthermia * The patient used to test drug allergies or other contraindications * Over the past 30 days participated in other clinical drug research
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| TOF ratio | Time from administration to TOF (T4/T1) values recovered to 90%,an expected average of 25-30 minutes |
Secondary
| Measure | Time frame |
|---|---|
| Steward score | Time from the end of operation to extubation period,an expected average of 15 minutes |
| Ramsay score | Time from the end of operation to extubation period,an expected average of 15 minutes |
| Mivacurium induced time | Time from intravenous injection of mivacurium to T1 reached the maximum inhibition time,an expected average of 3-5 minutes |
| Total duration of action | Time from the Mivacurium injection up to recovery from the neuromuscular blockade to 95% of the initial value,an expected average of 25-30 minutes |
| Recovery index | Time between a 25% and 75% recovery from a neuromuscular blockade,an expected average of 6-8 minutes |
| Change of the mean arterial pressure (MAP) and heart rate (HR) during pulling out the endotracheal tube period | 10 minutes before pulling the endotracheal tube, the moment of pulling the endotracheal tube immediately, pull out the endotracheal tube after 5 min |
| Clinical duration of action | Time from the Mivacurium injection up to recovery from the neuromuscular blockade to 25% of the initial value, an expected average of 12-20 minutes |
Countries
China
Contacts
Primary Contactzhao xiaoyong, master
Outcome results
None listed