Increased sensitivity to vecuronium and prolonged duration of its action in patients with end-stage renal failure.

Abstract

STUDY OBJECTIVES:

To determine whether the duration of action of vecuronium is influenced by chronic renal failure.

DESIGN:

Prospective clinical comparison.

SETTING:

Operating room, Hokkaido University Hospital.

PATIENTS:

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).

INTERVENTIONS:

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.

MEASUREMENTS:

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.

MAIN 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.

• Authors: H Sakamoto, K Takita, O Kemmotsu, Y Morimoto, T Mayumi
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 13 Issue 3 Pg. 193-7 (May 2001) ISSN: 0952-8180 [Print] United States
• PMID: 11377157 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Neuromuscular Nondepolarizing Agents
• Vecuronium Bromide

Topics

• Adult
• Anesthesia
• Biotransformation
• Female
• Humans
• Kidney Failure, Chronic (complications)
• Kidney Function Tests
• Kidney Transplantation
• Male
• Monitoring, Intraoperative
• Neuromuscular Nondepolarizing Agents (pharmacokinetics)
• Physical Stimulation
• Prospective Studies
• Ulnar Nerve (physiology)
• Vecuronium Bromide (pharmacokinetics)