Objective To investigate the characteristics of the pharmacodynamics of rocuronium bromide in patients with hepatobiliary
disease. Methods Forty-eight patients undergoing abdominal surgery were divided into four groups, group A: patients with liver cirrhosis and portal hypertension (n = 12); group B1 : patients with cholelithiasis and obstructive jaundice (n = 12); group B2 : patients with cholelithiasis but no obstructive jaundice ( n=12);group C: patients without hepatobiliary disease ( n = 12) . Their renal function was normal. Patients with cardiovascular and neurological diseases were excluded. Premedication consisted of intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.05 mg·kg-1 , fentanyl 2μg·kg-1 , propofol 2 mg·kg-1 and rocuronium 0.6 mg·kg-1 . The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. Anesthesia was maintained with iv infusion of propofol and fentanyl.
Additional bolus dose of rocuronium 0.15 mg·kg-1 was given when T, recovered to 25% and each patient received six additional doses irrespective of duration of operation. Neuromuscular function was monitored using Datex-Ohmeda NMT mechanosensor. Onset time (from the end of injection to maximum depression of muscle twitch), clinical duration of intubating and additional dose (25 % recovery of T1 ) and recovery index (T1 from 25 % -75 %) were recorded. Results The demographic data were comparable among the four groups. The onset time was
significantly longer in group A than that in group B, , B2 and C ( P < 0.05). There was no significant difference in the clinical duration of intubating dose among the four groups. The clinical duration of the additional doses in group A and B1 was progressively prolonged and was significantly prolonged after the 4 th additional dose ( P < 0.05). The recovery index in group A, B1 and B2 was significantly longer than that in control group (group C). (P < 0.05 or 0.01) Conclusion Patients with liver cirrhosis are "resistant" to initial dose of rocuronium with longer onset time. Clinical duration after repeated doses and recovery index are significantly longer in patients with liver cirrhosis and obstructive jaundice.