Key result
Severe aortic regurgitation is linked to ~95% longer cisatracurium onset time versus normal cardiac function.
Why the study?
Severe aortic regurgitation may affect the pharmacodynamics and pharmacokinetics of cisatracurium during anesthetic induction, but this relationship was not well characterized.
Does severe aortic regurgitation affect the pharmacodynamics and pharmacokinetics of cisatracurium during anesthetic induction?
Observational (n=32)
No
Does severe aortic regurgitation affect the pharmacodynamics and pharmacokinetics of cisatracurium during anesthetic induction?
Severe aortic regurgitation significantly delays the onset of maximal neuromuscular block and alters the pharmacokinetics of cisatracurium during anesthetic induction, highlighting the need for muscular blockade monitoring in these patients.
Background This study was designed to examine whether severe aortic regurgitation will affect the pharmacodynamics (PD) and pharmacokinetics (PK) of cisatracurium during anesthetic induction. Methods A total of 32 patients were divided into two groups: the AR group (n=16) and the control group (n=16). Arterial blood samples were drawn before and at 1, 2, 4, 6, 8, 10, 16 and 20 minutes after intravenous injection of 0.15mg/kg cisatracurium. TOF tests were applied to determine the onset time of maximal muscle relaxation. The concentration of cisatracurium in plasma was determined by high-performance liquid chromatography. Results The onset time to maximal neuromuscular block was prolonged from 2.07(0.08) minutes to 4.03±0.14 minutes, which indicated that the PD responses to cisatracurium were significantly delayed in the AR group (P<0.05) compared to the control group. A conventional two-compartment PK model showed a higher plasma concentration of cisatracurium among the AR group with markedly reduced intercompartment transfer rate (K12= 0.19±0.02 and K21= 0.11±0.01 in the AR group vs. K12=0.26±0.01 and K21= 0.19±0.01 in the control group, P<0.01) compared to the control group. Conclusion Backward blood flow during diastole in severe AR impaired distribution of cisatracurium from the central compartment to the peripheral compartment, which accounted for the lagged PD responses.Findings in this study underlie the importance of muscular blockade monitoring among patients with severe aortic regurgitation during anesthetic induction.
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Huang et al. (2020) conducted an observational in Severe Aortic Regurgitation (n=32). Severe Aortic Regurgitation vs. Normal cardiac function was evaluated on Onset time to maximal neuromuscular block (minutes) (p=<0.05).
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