See the published version of this article at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Abnormal Cisatracurium Pharmacodynamics and Pharmacokinetics among Patients with Severe Aortic Regurgitation during Anesthetic Induction
Sheng Wang
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0065-0102
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background This study was designed to examine whether severe aortic regurgitation will affect the pharmacodynamics (PD) and pharmacokinetics (PK) of cisatracurium during anesthetic induction. Method s 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 (K 12 = 0.19±0.02 and K 21 = 0.11±0.01 in the AR group vs. K 12= 0.26±0.01 and K 21 = 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 neuromuscular blockade monitoring among patients with severe aortic regurgitation during anesthetic induction.
Keywords
cisatracurium, severe aortic regurgitation, neuromuscular blockade, intercompartment transfer rate
Figure 1
Figure 2
Figure 3
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 13 Jan, 2020
Published
On 22 Jan, 2020
No community comments so far
Submission checks complete
On 10 Jan, 2020
Editorial decision: Accept
On 08 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 06 Jan, 2020
Editor assigned
On 02 Jan, 2020
Submission checks complete
On 01 Jan, 2020
Editor invited
On 01 Jan, 2020
No comments provided
Editorial decision: Major revision
On 09 Dec, 2019
Review #2 received
Received 05 Dec, 2019
Review #1 received
Received 23 Nov, 2019
Reviewer #2 agreed
On 20 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Editor assigned
On 14 Nov, 2019
Submission checks complete
On 13 Nov, 2019
Editor invited
On 13 Nov, 2019
No comments provided
Editorial decision: Major revision
On 04 Nov, 2019
Submission checks complete
On 31 Oct, 2019
Editor assigned
On 24 Oct, 2019
Editor invited
On 23 Oct, 2019
First submitted
On 21 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
Learn more about our company.
This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Abnormal Cisatracurium Pharmacodynamics and Pharmacokinetics among Patients with Severe Aortic Regurgitation during Anesthetic Induction
Sheng Wang
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0065-0102
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 13 Jan, 2020
Published
On 22 Jan, 2020
No community comments so far
Submission checks complete
On 10 Jan, 2020
Editorial decision: Accept
On 08 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 06 Jan, 2020
Editor assigned
On 02 Jan, 2020
Submission checks complete
On 01 Jan, 2020
Editor invited
On 01 Jan, 2020
No comments provided
Editorial decision: Major revision
On 09 Dec, 2019
Review #2 received
Received 05 Dec, 2019
Review #1 received
Received 23 Nov, 2019
Reviewer #2 agreed
On 20 Nov, 2019
Reviewer #1 agreed
On 19 Nov, 2019
Reviewers invited
Invitations sent on 19 Nov, 2019
Editor assigned
On 14 Nov, 2019
Submission checks complete
On 13 Nov, 2019
Editor invited
On 13 Nov, 2019
No comments provided
Editorial decision: Major revision
On 04 Nov, 2019
Submission checks complete
On 31 Oct, 2019
Editor assigned
On 24 Oct, 2019
Editor invited
On 23 Oct, 2019
First submitted
On 21 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background This study was designed to examine whether severe aortic regurgitation will affect the pharmacodynamics (PD) and pharmacokinetics (PK) of cisatracurium during anesthetic induction. Method s 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 (K 12 = 0.19±0.02 and K 21 = 0.11±0.01 in the AR group vs. K 12= 0.26±0.01 and K 21 = 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 neuromuscular blockade monitoring among patients with severe aortic regurgitation during anesthetic induction.
Figure 1
Figure 2
Figure 3