Double transplantation of the liver and kidney. A study of curarization using continuously perfused atracurium

We report the use of atracurium besylate with monitoring of neuromuscular function in a young women with primary hyperoxaluria and no renal function. She underwent orthotopic liver transplantation and also a kidney graft during the same operation. The bolus dose (0.5 mg.kg-1) and the mean infusion rate (0.405 mg.kg-1.h-1) were similar to those reported in references. The infusion rate decreased during anhepatic period. Spontaneous recovery time from TR 25 to 75% was 36 mn and TR 90% was 127 mn, after the end of atracurium infusion. The depression of neuromuscular function was potentiated with isoflurane use, acidemia, hypocalcemia, hypothermia but without cumulative effect. It was concluded that the administration of atracurium by infusion is suitable for long surgical procedures despite impaired hepatic and renal function.