Increased sensitivity to vecuronium and prolonged duration of its action in patients with end-stage renal failure.
OBJECTIVE
To determine whether the duration of action of vecuronium is influenced by chronic renal failure.


METHODS
Prospective clinical comparison.


METHODS
Operating room, Hokkaido University Hospital.


METHODS
7 adult ASA physical status II and III patients with impaired renal function undergoing living-related renal transplantation (Group A), 5 adult ASA physical status II and III patients with impaired renal function undergoing elective surgery other than renal transplantation (Group B), and 13 adult ASA physical status I and II patients with normal hepatorenal function undergoing elective surgery (Group C).


METHODS
Anesthesia was induced with thiamylal 5 mg x kg(-1) and fentanyl 100 microg IV and maintained with 60% nitrous oxide and 1% isoflurane. An initial dose of vecuronium was administered and patients' tracheas were intubated.


METHODS
Neuromuscular function was monitored by acceleration of thumb adduction with train-of-four stimulation. Vecuronium 60 microg x kg(-1) was administered as the initial dose via a central catheter, and if the first twitch was more than 3% of the control, another dose of vecuronium 20 microg x kg(-1) was given as necessary. Both onset time and duration of action until 25% recovery were measured. Plasma vecuronium and its metabolite, 3-desacetyl-vecuronium, levels were measured at onset and at 25% recovery in Groups A and C.


RESULTS
The total dose of vecuronium and initial concentration of vecuronium showed no significant difference between Group A and Group C. Duration of action was significantly prolonged in Group A and Group B compared with Group C.


CONCLUSIONS
Duration of action of vecuronium is prolonged in patients with end-stage renal failure mainly due to higher sensitivity to vecuronium.
Sakamoto
H
H
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takita
K
K
Kemmotsu
O
O
Morimoto
Y
Y
Mayumi
T
T
D000328:Adult; D000758:Anesthesia; D001711:Biotransformation; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D016343:Monitoring, Intraoperative; D003473:Neuromuscular Nondepolarizing Agents / Q000493:pharmacokinetics; D010812:Physical Stimulation; D011446:Prospective Studies; D014459:Ulnar Nerve / Q000502:physiology; D014673:Vecuronium Bromide / Q000493:pharmacokinetics
D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide