[Recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction].
OBJECTIVE
Study of the recovery of neuromuscular block after continuous infusion of cisatracurium in patients with renal dysfunction.


METHODS
Prospective case-control study.


METHODS
Forty adult patients scheduled for urological surgery were assigned to two groups according to the creatinine clearance (CC) as a measure of the renal function: group IR (CC < 60 mL.min-1) or group NR (CC > or = 60 mL.min-1).


METHODS
After premedication with hydroxyzine, anaesthesia was induced with propofol, sufentanil and cisatracurium (0.15 mg.kg-1), and maintained using isoflurane, sufentanil and a continuous infusion of cisatracurium (0.12 mg.kg-1.h-1) adjusted for maintained a post-tetanic count < or = 5. Neuromuscular transmission was monitored at the adductor pollicis using accelerography (TOF Gard). Onset and recovery times in both groups were compared using Student's t test.


RESULTS
Infusion time and total dose of cisatracurium were comparable in both groups. Onset times were 3.9 +/- 0.8 min and 3.5 +/- 0.6 min in groups IR and NR respectively. After the infusion, the time to train-of-four ratio of 0.8 were not different in both groups: 77 +/- 18 min (group IR) and 73 +/- 13 min (group NR). However, the spontaneous recovery intervals 25%-75% were delayed in group IR (20 +/- 9 min vs 14 +/- 5 min p < 0.05).


CONCLUSIONS
There are minor differences in the pharmacodynamics of cisatracurium between patients with normal or impaired renal function. Nevertheless, a marked interindividual variability in the recovery parameters was observed in patients with renal dysfunction.
Sztark
F
F
Département d'anesthésie-réanimation I, CHU Pellegrin, 33076 Bordeaux, France. sztark@chu-bordeaux2.fr
Cantini
O
O
Bourdallé-Badie
C
C
Gardien
P L
PL
Erny
P
P
D000328:Adult; D000368:Aged; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000493:pharmacokinetics; D011446:Prospective Studies; D013520:Urologic Surgical Procedures
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium