The pharmacokinetics of d-tubocurarine with surgery involving salvaged autologous blood.
The disposition of d-tubocurarine (dTc) was assessed when a bolus and infusion dosage regimen was used to obtain relaxation during major orthopedic surgery on the spine. Renal clearance of dTc was 0.63 +/- 0.23 ml X min-1 X kg-1 and was correlated with creatinine clearance. Total plasma clearance of 1.21 +/- 0.40 ml X min X -1 X kg-1 was lower than that found in many previous studies, and the predetermined continuous dTc infusion produced an apparent plateau in plasma concentrations of 1.8 +/- 0.3 micrograms X ml-1. Despite the operative blood loss, these concentrations were greater than anticipated and were associated with a more intense neuromuscular blockade than the infusion was designed to produce. Autologous blood transfusion was used to reduce the reliance on homologous donor blood, and the erythrocytes from the 2.2 +/- 1.2 1 of blood loss during the procedure were reinfused after intraoperative salvage, washing, and centrifugation. With 80 +/- 23 mg dTc administered, 1.4 +/- 0.8% was recovered from the fluid discarded after centrifugation. These results indicate that even massive intraoperative blood loss will not entail a significant reduction in the amount of dTc present in the body.
D000328:Adult; D001804:Blood Transfusion, Autologous; D005260:Female; D006207:Half-Life; D006470:Hemorrhage / Q000097:blood / Q000378:metabolism*; D006801:Humans; D007263:Infusions, Parenteral; D007431:Intraoperative Complications; D007700:Kinetics; D008297:Male; D009126:Muscle Relaxation; D012600:Scoliosis / Q000601:surgery; D014018:Tissue Distribution; D014403:Tubocurarine / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism*
D014403:Tubocurarine