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Influence of the Pringle maneuver during partial hepatectomy on the neuromuscular block induced by intermittent and continuous dosing of rocuronium

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Abstract

Purpose

The Pringle maneuver (PM) is a common procedure in hepatectomy that is known to interrupt drug elimination. The purpose of this study was to examine the influence of PM on the duration of action of rocuronium administered by intermittent bolus dosing, the continuous rocuronium infusion dose required for maintenance of a moderate neuromuscular block, and changes in plasma concentrations of rocuronium.

Methods

Twenty-seven adult patients undergoing partial hepatectomy with PM were enrolled in this study. The duration of action of 0.2 mg/kg rocuronium boluses (DUR), and the continuous rocuronium infusion dose required for maintenance of the height of the first twitch of the train-of-four (T1) at 10–20% of the control value (%T1), respectively, were electromyographically monitored on the adductor digiti minimi muscle. The effects of PM on DUR, %T1, and the plasma concentration of rocuronium were measured.

Results

The DUR was significantly prolonged during PM [mean: 42.2 (SD: 8.0) min, P < 0.001] compared to baseline [29.7 (6.3) min]. It was prolonged even after completion of the PM [46.2 (10.5) min, P < 0.001]. The plasma concentration of rocuronium measured at every reappearance of T1 was comparable between before and during PM. %T1 [15.5 (5.6)%] was significantly depressed after the start of PM [6.5 (3.9)%, P < 0.001], with persistence of the depression even after completion of PM. However, there were no significant changes in the plasma concentration of rocuronium.

Conclusions

Rocuronium-induced neuromuscular block is significantly augmented during PM. However, the augmentation is not associated with an increase in plasma rocuronium concentration.

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Acknowledgements

The trial was prospectively registered at the UMIN Clinical Trial Registry (Intermittent dosing Study: No. UMIN000039290; Continuous infusion study: No. UMIN000039294 on January 28, 2020, and was supported by departmental funding. This work did not receive any granny, from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Mai Yamamoto, Shunichi Takagi, Miho Kijima, Hanae Sato, Akira Doshu-Kajiura, Osamu Kitajima & Takahiro Suzuki

Authors
  1. Mai Yamamoto
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  2. Shunichi Takagi
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  3. Miho Kijima
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  4. Hanae Sato
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  5. Akira Doshu-Kajiura
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  6. Osamu Kitajima
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  7. Takahiro Suzuki
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Contributions

Experimental design: TS, MY and ST. Data collection: MY, ST, ADK, MK and OK. Data analysis: MY, ST and TS. Writing the manuscript: MY. Editing the manuscript: TS. Review the manuscript: all authors.

Corresponding author

Correspondence to Takahiro Suzuki.

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Conflict of interest

Takahiro Suzuki has received speaker fee from MSD Inc., Japan. Takagi S has received speaker fee from MSD Inc., Japan and Nihon-Kohden, Japan. Other authors have no competing interests.

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Yamamoto, M., Takagi, S., Kijima, M. et al. Influence of the Pringle maneuver during partial hepatectomy on the neuromuscular block induced by intermittent and continuous dosing of rocuronium. J Anesth 37, 828–834 (2023). https://doi.org/10.1007/s00540-023-03239-8

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  • DOI: https://doi.org/10.1007/s00540-023-03239-8

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