Abstract
Atracurium is a new non-depolarising neuromuscular blocking agent, metabolized through Hofmann elimination. A case is presented in which a 45-year-old patient with severe liver disease showed a decreased response to atracurium. The possible causes of resistance to atracurium are discussed. We conclude that atracurium may be used in patients with severe hepatic disease.
Résumé
L’atracurium est un nouveau bloqueur neuro-musculaire non-dépolarisam métabolisé par élimination de Hofmann. Un cas est présenté dans lequel un patient de 45 ans avec une atteinte hépatique sévère a présenté une diminution de la réponse à l’atracurium. Les causes possibles de la résistance à l’atracurium sont discutées. On conclut que l’atracurium peut être utilisé chez les patients avec une atteinte hépatique sévère.
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Slenlake JB, Waigh RD, Urwin J, Dewar GH, Cooker CG. Atracurium; conception and inception. Br J Anaesth 1983; 55 (Suppl. l):3S-10S.
Chappie DJ, Clark JS. Pharmacological action of breakdown products of atracurium and related substances. Br J Anaesth. 1983; 55 (Suppl. 1):11S-15S.
Merrett RA, Thompson CW, Webb FW. In vitro degradation of atracurium in human plasma. Br J Anaesth 1983; 55:61–66.
Foldes FF, Nagashima H, Boros M, Tasfonyi E, Fitzal S, Agoslon S. Muscular relaxation with atracurium, vercuronium and duador under balanced anaesthesia. Br J Anaesth 1983; 55 (Suppl. 1):97S-103SS
Dundee JW, Gray TC. Resistance to d-tubocurarine chloride in the presence of liver damage. Lancet 1953; 2, 16–7.
Aladjemoff L, Dilestein S, Shafir E. Binding of d-tubocurarine chloride to plasma proteins. J. Pharmacol Exp Ther 1958; 123:43–88.
Baraka A, Gabali F. Correlation between tubocurarine requirements and plasma protein pattern. Br J Anaesth 1968; 40:89–933.
Slovner J, Theodorsen L, Bjelke E. Sensitivity to tubocurarine and alcuronium with special reference to plasma protein pattern. Br J Anaesth 1971; 43:3855.
Stovner J, Theodorsen L, Bjelke E. Sensitivity to gallamine and pancuronium with special reference to serum proteins. Br J Anaesth 1971; 43:9533.
Somogyi AA, Shanks CA, Triggs EJ. Disposition kinetics of pancuronium bromide in patients with total biliary obstruction. Br J Anaesth 1977; 49:1103–88.
Duvaldestin P, Agoston S, Henzel D et al. Pancuronium pharmacokinetics in patients with liver cirrhosis. Br J Anaesth 1978; 50:131–66.
Foldes F, Deery A. Protein binding of atracurium and other short acting neuromuscular blocking agents and their interaction with human cholinesterase. Br J Anaesth 1983; 55 (Suppl. 1):31S-34S.
Macleod J. Principles and Practice of Medicine. 2nd Ed. Edinburgh, Churchill Livingstone: 1978; 430.
Stirt JA, Kan RL, Murray AL, Schelhl DL, Lee C. Modification of atracurium blockade by halothane and suxamcthonium. A review of clinical experience. Br J Anaesth 1983; 55 (Suppl. 1):71S-5S.
Kaufman K. Serum cholinesterase activity in the normal individual and in people with liver disease. Ann Int Med 1954; 41:533–455.
Faber M. The relationship between serum cholinesterase and serum albumin. Acta Med Scand 1943; 114:72–911.
Kunkel HG, Ward SM. Plasma esterase activity in patients with liver disease and nephrotic syndrome. Journal of Experimental Medicine 1947; 86:325–377.
Whittaker M. Plasma cholinesterase variants and the anaesthetist. Anaesthesia 1980; 35:174–977.
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Gyasi, H.K., Naguib, M. Atracurium and severe hepatic disease: a case report. Can Anaesth Soc J 32, 161–164 (1985). https://doi.org/10.1007/BF03010043
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DOI: https://doi.org/10.1007/BF03010043