DURATION OF ROCURONIUM-INDUCED NEUROMUSCULAR BLOCK DURING LIVER-TRANSPLANTATION - A PREDICTOR OF PRIMARY ALLOGRAFT FUNCTION

The prolongation of vecuronium-induced neuromuscular block has been re ported as a predictor of hepatic allograft dysfunction. This study inv estigates the duration of action of rocuronium, which also relies on h epatic clearance, to examine whether it also is prolonged with allogra ft dysfunction. Fifty-seven patients undergoing orthotopic liver trans plant were given rocuronium (0.6 mg/kg) prior to allograft placement a nd the recovery of contraction of the orbicularis oculi muscle to a 2- Hz train-of-four stimulus was recorded. Fifteen minutes after reperfus ion of the allograft, rocuronium (0.6 mg/kg) was administered and the time to recovery of muscle contraction to a train-of-four stimulus (tr ain-of-four time) was again recorded. The patients were divided into t wo groups according to posttransplant liver function. Group I consiste d of 50 patients with immediate normal liver function. Group II contai ned 7 patients with primary dysfunctional livers. Primary dysfunction was determined by peak serum aspartate aminotransferase and alanine am inotransferase levels > 2000 U/L, and prothrombin time > 16 s. The tra in-of-four time in Group II was prolonged compared with Group I (P < 0 .05). Immediate graft function testing using the recovery time from ro curonium of > 150 min has a positive predictive value of 100% and a ne gative predictive value of 96%. The sensitivity and specificity is 71% and 100%, respectively. Receiver operating characteristic analysis su pports this conclusion.