Rocuronium is more hepatotoxic than succinylcholine in vitro

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Abstract

BACKGROUND

The development of liver failure is a major problem in critically ill patients. The hepatotoxicity of many drugs, as one important reason for liver failure, is poorly screened for in human models. Rocuronium and succinylcholine are neuromuscular blocking agents used for tracheal intubation and for rapid-sequence induction.

OBJECTIVE

We used an in-vitro test with a permanent cell line and compared rocuronium and succinylcholine for hepatotoxicity.

DESIGN

In-vitro study.

SETTING

A basic science laboratory, University Hospital Rostock, Germany.

MATERIAL/(PATIENTS)

The basic test compound is the permanent human liver cell line HepG2/C3A. In a standardised microtitre plate assay the toxicity of different concentrations of rocuronium, succinylcholine and plasma control was tested.

INTERVENTIONS

After two incubation periods of 3 days, the viability of cells (XTT test, lactate dehydrogenase release and trypan blue staining), micro-albumin synthesis and the cytochrome 1A2 activity (metabolism of ethoxyresorufin) were measured.

MAIN OUTCOME MEASURES

Differences between rocuronium and succinylcholine were assessed using the Kruskal–Wallis one-way test and two-tailed Mann–Whitney U test.

RESULTS

Rocuronium, but not succinylcholine, led to a significant dose-dependent decrease of viability, albumin synthesis and cytochrome 1A2 activity of test cells.

CONCLUSION

An in-vitro test with a cell line showed hepatotoxicity of rocuronium that was dose-dependent. Further studies are needed to investigate the underlying mechanisms of the effects of rocuronium on hepatic cellular integrity.

TRIAL REGISTRATION

Not suitable.

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