title: [The action of bupivacaine-HCl following supraclavicular plexus block in patients with chronic kidney insufficiency].
abstract: A reduced duration of activity of local anesthetic drugs in patients with chronic renal failure has been described by several authors. Because surgical duration is not always predictable and these patients must be classified as high-risk patients (ASA physical status III-IV), reduced effectiveness may be a significant problem in clinical practice. Various reasons have been discussed as possible explanations for this phenomenon such as: (1) uremia-induced changes in acid-base status of blood and tissue, (2) alterations in protein-binding; and (3) changes in hemodynamic parameters. However, we have not been able to find any severe changes in electrolyte or acid-base status in patients with chronic renal failure after adequate hemodialysis. We wondered, therefore, whether changes in tissue pH might be one cause of the shorter duration of action of anesthetic drugs. We also examined some other pharmacokinetic parameters after administration of the anesthetic drug in order to find differences in comparison to healthy patients. Supraclavicular brachial blockade (3 mg/kg bupivacaine 0.5% + 0.1 IU vasopressin/ml) was performed in 11 patients with chronic renal failure requiring hemodialysis who were admitted to the hospital for a shunt operation in the forearm. The control group consisted of 11 healthy patients who were admitted for minor hand surgery. Preoperative blood samples were taken for measurement of blood urea nitrogen, serum creatinine, serum electrolytes, lactate, hemoglobin and hematocrit, and an arterial blood gas duration of action was defined as the time to full recovery of sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Abteilung für Anaesthesiologie, Städtisches Krankenhaus Köln-Merheim.
authors.forename: G
authors.initials: G
authors.lastname: Wald-Oboussier
authors.forename: B
authors.initials: B
authors.lastname: Viell
authors.forename: J
authors.initials: J
authors.lastname: Biscoping
mesh_terms: D000368:Aged; D001917:Brachial Plexus; D002045:Bupivacaine; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block
chemical_list: D002045:Bupivacaine
vernacular_title: Die Wirkung von Bupivacain-HCl nach supraklavikulärer Plexusblockade bei Patienten mit chronischer Niereninsuffizienz.