Journal of Anesthesia

, Volume 24, Issue 5, pp 683–686 | Cite as

Vecuronium requirement during liver transplantation under sevoflurane anesthesia

  • Kook-Hyun Lee
  • Soon-Ho Nam
  • Seung-Yeon Yoo
  • Chul-Woo Jung
  • Seng-Sim Bae
  • Jeong-Rim LeeEmail author
Original Article



In liver transplantation patients under intravenous anesthesia, the vecuronium dose is known to be reduced, especially during the anhepatic phase. Volatile anesthetics potentiate a muscle relaxation effect of neuromuscular blocking agents, so the vecuronium dose is supposed to further decrease if sevoflurane is used during liver transplantation. The purpose of this study was to determine the appropriate dose of vecuronium at each phase of liver transplantation under sevoflurane anesthesia.


Thirty-five patients scheduled for living donor liver transplantation because of liver cirrhosis were enrolled in this study. They were anesthetized with 1 MAC of sevoflurane and intermittent administration of fentanyl. Continuous infusion of vecuronium (0.5 mg/ml) was used for muscle relaxation, which was adjusted every 15 min for consistent muscle relaxation aimed at T1/Tc of 0.1 monitored by ulnar nerve stimulation. Vecuronium infusion was stopped after hepatic artery anastomosis was finished. The infusion rate of each operative phase—dissection, anhepatic, and neohepatic—was calculated and analyzed by one-way analysis of variance. The recovery time from train-of-four (TOF) count 1 to TOF ratio 25% was also measured.


The vecuronium infusion rate of each operation phase for adequate muscle relaxation was as follows: 0.033 ± 0.009 mg/kg/h during dissection phase, 0.031 ± 0.009 mg/kg/h during anhepatic phase, and 0.026 ± 0.006 mg/kg/h during early neohepatic phase. There was a statistically significant difference between doses at each phase (P = 0.033). The recovery time from TOF count 1 to TOF ratio 25% was 103 ± 29 min.


The required vecuronium dose in all phases was less than the known dose in the anhepatic phase (0.036 mg/kg/h) under midazolam-fentanyl anesthesia. In addition, the vecuronium infusion dose was not reduced in the anhepatic phase compared to the dissection phases.


Liver transplantation Sevoflurane Vecuronium 


  1. 1.
    Adachi T. Anesthetic principles in living-donor liver transplantation at Kyoto University Hospital: experiences of 760 cases. J Anesth. 2003;17:116–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Segawa H. Perspectives in living donor and recipient perioperative care from Japan. Int Anesthesiol Clin. 2006;44:111–24.CrossRefPubMedGoogle Scholar
  3. 3.
    O’Kelly B, Jayais P, Veroli P, Lhuissier C, Ecoffey C. Dose requirements of vecuronium, pancuronium, and atracurium during orthotopic liver transplantation. Anesth Analg. 1991;73:794–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Lowry DW, Mirakhur RK, McCarthy GJ, Carroll MT, McCourt KC. Neuromuscular effects of rocuronium during sevoflurane, isoflurane, and intravenous anesthesia. Anesth Analg. 1998;87:936–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Wulf H, Kahl M, Ledowski T. Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anesthesia. Br J Anaesth. 1998;80:308–12.PubMedGoogle Scholar
  6. 6.
    Ahmed AA, Kumagai M, Otake T, Kurata Y, Amaki Y. Sevoflurane exposure time and the neuromuscular blocking effect of vecuronium. Can J Anaesth. 1999;46:429–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Suzuki T, Munakata K, Watanabe N, Katsumata N, Saeki S, Ogawa S. Augmentation of vecuronium-induced neuromuscular block during sevoflurane anaesthesia: comparison with balanced anaesthesia using propofol or midazolam. Br J Anaesth. 1999;83:485–7.PubMedGoogle Scholar
  8. 8.
    Cannon JE, Fahey MR, Castagnoli KP, Furuta T, Canfell PC, Sharma M, Miller RD. Continuous infusion of vecuronium: the effect of anesthetic agents. Anesthesiology. 1987;67:503–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Motamed C, Donati F. Sevoflurane and isoflurane, but not propofol, decrease mivacurium requirements over time. Can J Anaesth. 2002;49:907–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Lukin CL, Hein HA, Swygert TH, Gunning TC 3rd, Valek TR, Donica SK, Nelson RB 3rd, Ramsay MA. Duration of vecuronium-induced neuromuscular block as a predictor of liver allograft dysfunction. Anesth Analg. 1995;80:526–33.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2010

Authors and Affiliations

  • Kook-Hyun Lee
    • 1
  • Soon-Ho Nam
    • 2
  • Seung-Yeon Yoo
    • 1
  • Chul-Woo Jung
    • 1
  • Seng-Sim Bae
    • 1
  • Jeong-Rim Lee
    • 2
    Email author
  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University College of MedicineSeoulKorea
  2. 2.Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea

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