title: The pharmacodynamics and pharmacokinetics of vecuronium in patients anesthetized with isoflurane with normal renal function or with renal failure.
abstract: The duration of action and the pharmacokinetics of vecuronium were compared in patients with and without renal function. Twenty patients were studied: 12 with renal failure who were to receive kidney transplants from cadaveric donors, and eight with normal renal function. After oral premedication with diazepam, 10 mg, anesthesia was induced with thiopental, 4 mg/kg iv, and maintained with the inhalation of 60% nitrous oxide and 0.9-1.1% isoflurane, end-tidal concentration, in 40% oxygen. The force of thumb adduction in response to supramaximal ulnar nerve stimulation was monitored and recorded. An intravenous bolus of vecuronium, 0.1 mg/kg, was administered after 15 min of a stable end-tidal isoflurane concentration, as measured by mass spectrometry. Venous blood was then sampled at frequent intervals for 4 h following the bolus. Vecuronium concentrations in plasma were quantified by a sensitive and specific gas chromatographic assay. Data were analyzed by nonlinear least squares regression and described by a two-compartment model. The duration of neuromuscular blockade was longer in patients with renal failure than in those with normal renal function. This increased duration may be related to both a decreased plasma clearance and a prolonged elimination half-life of vecuronium in the renal failure group.
mesh_terms: D000769:Anesthesia, Inhalation; D006801:Humans; D007530:Isoflurane; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology*; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology; D013997:Time Factors; D014673:Vecuronium Bromide / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology*
chemical_list: D014673:Vecuronium Bromide; D007530:Isoflurane