[Cisatracurium in patients with compromised kidney function. Pharmacodynamic and intubation conditions under isoflurane-nitrous oxide anesthesia].
OBJECTIVE
The choice of cisatracurium, especially for patients with organ dysfunction, seems to be beneficial, because of organ-independent Hofmann-elimination and less histamine release propensity. This study was designed to investigate pharmacodynamics and intubating conditions after bolus administration of 0.15 mg/kg cisatracurium (3 x ED95) in patients with renal failure and maintained with isoflurane/N2O in oxygen.


METHODS
20 patients with renal failure and 19 patients with normal renal function were studied. Anaesthesia was induced with fentanyl (2-3 micrograms/kg) and thiophentone (4-7 mg/kg). After rapid bolus administration of 0.15 mg/kg cisatracurium (3 x ED95), onset time and intubating conditions were assessed. Clinical duration (DUR 25%), recovery index and duration 90% were investigated by acceleromyography. Changes of mean arterial blood pressure and/or heart rate > or = 20% were defined as clinically significant.


RESULTS
The onset time (3.1 +/- 0.8 min) was shorter in patients without renal failure (Cis-1) than in patients with normal renal function (3.6 +/- 0.8 min), but without statistical significance. Intubating conditions, scored according to a 3-step scale, were slightly better in patients with normal renal function. Other pharmacodynamic parameters did not differ significantly. However, a small tendency to a prolonged recovery with a wide inter-individual variety was characteristic for patients with renal failure. Regarding the hemodynamic actions, only minor individual cardiovascular changes occured. No clinical evidence of histamine release was observed in any patient.


CONCLUSIONS
The result of this clinical study suggest, that cisatracurium is a suitable choice for patients with renal failure. The necessity for an intraoperative neuromuscular monitoring is given by the marked heterogeneity in the recovery parameters in patients with renal failure.
Klinik für Anästhesiologie und operative Intensivmedizin der Martin-Luther-Universität Halle-Wittenberg.
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Soukup
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Czeslick
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Bunk
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Clausen
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Menzel
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Radke
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006636:Histamine Release / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D009609:Nitrous Oxide; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000378:metabolism* / Q000601:surgery
D018685:Anesthetics, Inhalation; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009609:Nitrous Oxide; C101584:cisatracurium
Cisatracurium bei Patienten mit eingeschränkter Nierenfunktion. Pharmakodynamik und Intubationsbedingungen unter Isofluran-Lachgas-Anästhesie.