Vecuronium Requirements According to the Operation Phase During Liver Transplantation Under Desflurane Anesthesia

• vecuronium requirements during preanhepatic phase [ Time Frame: during prehepatic phase of liver transplantation ] [ Designated as safety issue: No ]
  total vecuronium requirements as guided by Train-of-four neuromuscular monitoring during preanhepatic phase
• vecuronium requirements during anhepatic phase [ Time Frame: during anhepatic phase of liver transplantation ] [ Designated as safety issue: No ]
  total vecuronium requirements as guided by Train-of-four neuromuscular monitoring during anhepatic phase
• vecuronium requirements during neohepatic phase [ Time Frame: during neohepatic phase of liver transplantation ] [ Designated as safety issue: No ]
  total vecuronium requirements as guided by Train-of-four neuromuscular monitoring during neohepatic phase

The vecuronium requirements may be reduced for recipients of living donor liver transplantation, as the vecuronium is eliminated principally by the liver. Furthermore, the requirements may be different according to the phase of surgery. The requirements may also be different according to the preoperative hepatic function as measured by MELD score during prehepatic phase, or graft to recipient body weight ratio (GRWR) during neohepatic phase. Therefore, the investigators are trying to investigate the difference of vecuronium requirements according to the phase of surgery or MELD score, GRWR.

The vecuronium requirements may be reduced for recipients of living donor liver transplantation, as the vecuronium is eliminated principally by the liver. Furthermore, the requirements may be different according to the phase of surgery. The requirements may by further reduced during anhepatic phase of liver transplantation. And the requirements may be increased as the graft functions during neohepatic phase.

We also postulated that the requirements may be different according to the preoperative hepatic function during preanhepatic phase, and according to the graft to recipient body weight ratio (GRWR) during neohepatic phase.

Therefore, we are trying to investigate the difference of vecuronium requirements according to the phase of surgery, MELD score, GRWR.

Patients undergoing elective living donor liver transplantation

• High MELD group
  Preoperative MELD score greater than 20
• Low MELD group
  Preoperative MELD score lesser than 20

Inclusion Criteria:

• patients undergoing elective living donor liver transplantation

Exclusion Criteria:

• patients who can not undergo train-of-four test due to central or peripheral neuromuscular disease.
• patients with severe cardiopulmonary diseases.
• patients who received transfusion with more than 10 units of packed red blood cells.
• primary non-functioning graft immediately after reperfusion of the graft.
• patients who administered drugs that influences the metabolism of vecuronium (such as anticonvulsant: phenytoin, carbamazepine, primidone, sodium valproate)
• patients undergoing cadaver donor liver transplantation