Pharmacodynamics of cisatracurium in adults and children undergoing living donor liver transplantation

This study aims to investigate the pharmacodynamics of bolus administration of cisatracurium in adults and children undergoing living donor liver transplantation. Forty-two patients (ASA III) undergoing living donor liver transplantation were assigned to group A (21 adults) or group B (21 children affected by congenital biliary atresia). All patients received a 2 fold ED95 of cisatracurium (0.1 mg/kg) to facilitate the tracheal intubation and neuromuscular blocking was monitored by train-of-four. An additional dose of cisatracurium (0.03 mg/kg) was given once T1 recovered to 25% or 4 train-of-four (TOF) responses observed. Cisatracurium administration and sevoflurane inhalation were stopped in pre-anhepatic phase, anhepatic phase, and after portal reperfusion, but recontinued when T1 recovered to 75%. The delivery interval and recovery of muscular blockade were recorded. The onset time of cisatracurium was significantly shorter in adults, however, it did not show any difference to facilitate the tracheal intubation between adults and children undergoing living donor liver transplantation Children in group B experienced significantly higher incidence of metabolic acidosis, cholestasis, hyperlactacidemia and cellular destruction. The delivery interval and the duration of cisatracurium within these three phases were similar for adult or children the recovery index in group B was significantly lower than that in group B In conclusion, a 2 × ED95 dose of cisatracurium can provide a favorable condition for tracheal intubation for either adult or children undergoing living donor liver transplantation. However, children usually have a significantly longer onset time and a shorter recovery time the interval of the cisatracurium administration does not change with age.