Radkowski Paweł, Szewczyk Maciej, Łęczycka Anna, Kowalczyk Kacper, Kęska Mariusz, Stompór Tomasz
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland.
Department of Anesthesiology and Intensive Care, Regional Specialist Hospital, Olsztyn, Poland.
Med Sci Monit. 2025 Jan 1;31:e945822. doi: 10.12659/MSM.945822.
Skeletal muscle relaxants have found wide application in anesthesiology. They are used during surgeries, to support mechanical ventilation, or as an aid for safe intubation. Their use is associated with the creation of a conduction block at the neuromuscular junction. To terminate the neuromuscular blockade or to prevent residual blockade, another group of drugs called reversal agents is used. These include drugs like neostigmine and sugammadex. Many factors may influence the duration and potency of skeletal muscle relaxants, including dysfunctions of organs such as the kidneys or liver. Liver damage can have various etiologies - it can be toxic drug-induced, or due to the ingestion of toxic substances, viral infections, or alcohol consumption. In recent years, there have been increasing reports on the impact of metabolic disorders on liver steatosis and damage. The liver is responsible for the metabolism of many drugs, the excretion of metabolites into bile, and protein production. Progressive liver damage can lead to its remodeling, and eventually to cirrhosis and failure. Liver dysfunction can be associated with numerous systemic complications. A decrease in protein synthesis causes a decrease in the binding of drugs to plasma proteins, a decrease in the volume of distribution, and an increased amount of free drug forms in the body. Liver failure can affect the metabolism of some skeletal muscle relaxants and neuromuscular blockade reversal agents. This article aims to review the role of muscle relaxants in anesthesia for patents with liver disease.
骨骼肌松弛剂在麻醉学中已得到广泛应用。它们用于手术期间，以支持机械通气，或作为安全插管的辅助手段。它们的使用与神经肌肉接头处传导阻滞的形成有关。为了终止神经肌肉阻滞或预防残余阻滞，会使用另一类称为逆转剂的药物。这些药物包括新斯的明和舒更葡糖等。许多因素可能影响骨骼肌松弛剂的作用持续时间和效力，包括肾脏或肝脏等器官的功能障碍。肝损伤可有多种病因——可能是药物毒性所致，或因摄入有毒物质、病毒感染或饮酒引起。近年来，关于代谢紊乱对肝脂肪变性和损伤影响的报道越来越多。肝脏负责多种药物的代谢、将代谢产物排泄到胆汁中以及蛋白质的生成。进行性肝损伤可导致肝脏重塑，最终发展为肝硬化和肝衰竭。肝功能障碍可伴有许多全身并发症。蛋白质合成减少会导致药物与血浆蛋白的结合减少、分布容积减小以及体内游离药物形式的量增加。肝衰竭会影响一些骨骼肌松弛剂和神经肌肉阻滞逆转剂的代谢。本文旨在综述肌肉松弛剂在肝病患者麻醉中的作用。
