Atracurium, cisatracurium, vecuronium and rocuronium in patients with renal failure.
OBJECTIVE
The cumulative index, the recovery, the onset and the duration of action, of atracurium, cisatracurium, vecuronium and rocuronium in uremic patients undergoing kidney transplantation compared to healthy patients undergoing general surgery were studied.


METHODS
In all patients (64 uremic vs 62 "healthy" patients) after anesthesia induction, atracurium 0.5 mgxkg(-1) or cisatracurium 0.15 mgxkg(-1) or vecuronium 0.1 mgxkg(-1) or rocuronium 0.6 mgxkg(-1) were administered, and at the end of surgery when T1 reached 25% neostigmine 0.05 mgxkg(-1) was given. Neuro-muscu-lar transmission was monitored by accelerometry (TOF-GUARD, Organon).


RESULTS
Cumulative index of vecuronium (1.3+/-0.1 vs 1.06+/-0.11, p<0.001) and rocuronium (1.45+/-0.18 vs 1.04+/-0.16, p<0.001), recovery index (time of T1 25-75) of atracurium (14.2+/-5 vs 9+/-4, p<0.005), cisatracurium (18.7+/-3 vs 9.1, p<0.001), vecuronium (18.5+/-3 vs 12.5+/-3, p<0.001) and rocuronium (18+/-6 vs 11+/-4, p<0.001) and interval T1 25% to TOF 0.8 of cisatracurium (20.5+/-1.2 vs 16+/-2.1, p<0.001) and vecuronium (27+/-6.3 vs 20+/-3.3, p<0.001) were longer in uremic patients. The onset time and the duration of action of atracurium, cisatracurium, vecuronium and rocuronium were similar in all groups compared to controls one.


CONCLUSIONS
In patients with renal failure the use of atracurium, cisatracurium, vecuronium and rocuronium is suitable and predictable in terms of onset, and duration of action. Care has to be taken to vecuronium and rocuronium cumulative index. Neuromuscular trasmission has to be always monitored.
Della Rocca
G
G
Department of Anaesthesia, University of Udine, Udine, Italy. giorgio.dellarocca@dsc.uniud.it
Pompei
L
L
Coccia
C
C
Costa
M G
MG
Cecchini
V
V
Vilardi
V
V
Pietropaoli
P
P
D000328:Adult; D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors / Q000493:pharmacokinetics; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000493:pharmacokinetics; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009388:Neostigmine / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors / Q000493:pharmacokinetics*; D000077123:Rocuronium; D013997:Time Factors; D014511:Uremia / Q000378:metabolism* / Q000601:surgery; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors / Q000493:pharmacokinetics
D000732:Androstanols; D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009388:Neostigmine; D014673:Vecuronium Bromide; C101584:cisatracurium; D000077123:Rocuronium