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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2003 July-August;69(7-8):605-15

language: English, Italian

Atracurium, cisatracurium, vecuronium and rocuronium in patients with renal failure

Della Rocca G. 1, Pompei L. 1, Coccia C. 1, Costa M. G. 1, Cecchini V. 1, Vilardi V. 2, Pietropaoli P. 3

1 Department of Anaesthesia, University of Udine, Udine, Italy
2 Unit of General and Special Odontostomatologic Anaesthesia, «Tor Vergata», University of Rome, Rome, Italy
3 Department of Anaesthesiological Sciences, Critical Care Medicine and Pain Therapy,«La Sapienza», University of Rome,Rome, Italy


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Aim. 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 mg·kg-1 or cisatracurium 0.15 mg·kg-1 or vecuronium 0.1 mg·kg-1 or rocuronium 0.6 mg·kg-1 were administered, and at the end of surgery when T1 reached 25% neostigmine 0.05 mg·kg-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.
Conclusion. 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.

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