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Excerpt
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
J. Clin. Anesth., 13: 193–197, 2001
Whether the duration of action of vecuronium is influenced by chronic renal failure was ascertained in a prospective clinical comparison of seven ASA physical status II and III patients in the operating room at Hokkaido University Hospital. The patients (group A), all of whom had impaired renal function, were undergoing living-related renal transplantation; 5 adult ASA physical status II and III (group B) with impaired renal function were undergoing elective surgery other than renal transplantation, and 13 adult ASA physical status I and II (group C) patients with normal hepatorenal function were undergoing elective surgery. Anesthesia was induced with thiamylal 5 mg/kg and fentanyl 100 μg intravenously and maintained with 60% nitrous oxide and 1% isoflurane. An initial dose of vecuronium was given, and patients’ tracheas were intubated. Acceleration of thumb adduction with train-of-four stimulation was used to monitor neuromuscular function. Vecuronium 60 μg/kg was given as the initial dose through a central catheter, and if the first twitch was more than 3% of the control, another dose of vecuronium 20 μg/kg was administered as needed. Both onset time and duration of action until 25% recovery were measured. Levels of plasma vecuronium and its metabolite, 3-desacetyl-vecuronium, were measured at onset and at 25% recovery in groups A and C. No marked differences were seen between groups A and C in the total dose of vecuronium and the initial concentration of vecuronium. The duration of action was markedly longer in groups A and B compared with group C. The duration of action of vecuronium is prolonged in patients with end-stage renal function, mainly because of higher sensitivity to vecuronium.
