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

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% neo-stigmine 0.05 mg.kg - 1 was given. Neuro-muscular 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.