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The neuromuscular effects of 0.6 mg kg−1 rocuronium in elderly and young adults with or without renal failure*

Published online by Cambridge University Press:  01 November 2008

S. Kocabas ,
D. Yedicocuklu  and
F. Z. Askar
S. Kocabas*
Affiliation:
Ege University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
D. Yedicocuklu
Affiliation:
Ege University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
F. Z. Askar
Affiliation:
Ege University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
*
Correspondence to: Seden Kocabas, Cemal Gursel Caddesi, 418/9, Gunaydin Apt, 35530 Karsiyaka-Izmir, Turkey. E-mail: nskocabas@yahoo.com.tr; Tel: +90 232 3695394; Fax: +90 232 3390002
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Summary

Background and objectives

The elderly represent a wide and increasing patient population and significant numbers of elderly patients have chronic renal disease. This study aimed to investigate the neuromuscular effects of 0.6 mg kg−1 rocuronium under propofol anaesthesia in young adults and elderly patients with or without renal failure.

Methods

The neuromuscular effects of rocuronium 0.6 mg kg−1 under propofol anaesthesia were investigated in 40 patients with renal failure undergoing arteriovenous shunt surgery, of whom 20 were young adults (18–50 yr) and 20 were elderly (>65 yr) and in 40 patients with normal renal function undergoing peripheral venous surgery, of whom 20 were young adults and 20 were elderly. Neuromuscular transmission was monitored using acceleromyography. The times to recovery of the twitch (T1) to 25%, 50%, 75% and 90% and of the train-of-four ratio to 70%, and the recovery index were recorded.

Results

The times to recovery of the first twitch to 25%, 50%, 75% and 90% and train-of-four to 70% and recovery index were found to be prolonged in both young and elderly patients with renal failure compared to those with normal renal function (e.g. T1 25%: 58.4 ± 20.2 and 80.1 ± 23.7 min vs. 32.8 ± 5.6 and 46.3 ± 9.0 min, respectively) (P < 0.05). These parameters were also prolonged in the elderly when compared with young adults in both the renal failure and the non-renal failure groups.

Conclusions

The neuromuscular effects of 0.6 mg kg−1 rocuronium under propofol anaesthesia were markedly prolonged in young and elderly renal failure patients compared to patients with normal renal function, and also in elderly patients with normal renal function compared with young adults.

Keywords

NEUROMUSCULAR NON-DEPOLARIZER AGENTSPHARMACODYNAMICSKIDNEY FAILURE CHRONICAGED
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 940 - 946
Copyright
Copyright © European Society of Anaesthesiology 2008

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Footnotes

*

This study was presented at the Euroanaesthesia Congress, Munich, 9–12 June 2007.

References

1.Sparr, HJ, Beaufort, TM, Fuchs-Buder, T. Newer neuromuscular blocking agents. How do they compare with established agents? Drugs 2001; 61: 919–942.CrossRefGoogle ScholarPubMed
2.McCourt, KC, Salmela, L, Mirakhur, RK et al. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia 1998; 53: 867–871.CrossRefGoogle ScholarPubMed
3.Proost, JH, Eriksson, LI, Mirakhur, RK, Roest, G, Wierda, JMKH. Urinary, biliary and faecal excretion of rocuronium in humans. Br J Anaesth 2000; 85: 717–723.Google Scholar
4.Wierda, JMKH, Kleef, UW, Lambalk, LM, Kloppenburg, WD, Agoston, S. The pharmacodynamics and pharmacokinetics of Org 9426, a new non-depolarizing neuromuscular blocking agent, in patients anaesthetized with nitrous oxide, halothane and fentanyl. Can J Anaesth 1991; 38: 430–435.CrossRefGoogle ScholarPubMed
5.Robertson, EN, Driessen, JJ, Booij, LHD. Pharmacokinetics and pharmacodynamics of rocuronium in patients with and without renal failure. Eur J Anaesthesiol 2005; 22: 4–10.Google Scholar
6.Flood, P. The importance of myorelaxants in anesthesia. Curr Opin Pharmacol 2005; 5: 322–327.CrossRefGoogle ScholarPubMed
7.Duvaldestin, P, Saada, J, Berger, JL, D’Hollander, A, Desmonts, JM. Pharmacokinetics, pharmacodynamics, and dose–response relationships of pancuronium in control and elderly subjects. Anesthesiology 1982; 56: 36–40.CrossRefGoogle ScholarPubMed
8.Lien, CA, Matteo, RS, Ornstein, E, Schwartz, AE, Diaz, J. Distribution, elimination, and action of vecuronium in the elderly. Anesth Analg 1991; 73: 39–42.Google Scholar
9.McCarthy, G, Elliott, P, Mirakhur, RK, Cooper, R, Sharpe, TD, Clarke, RS. Onset and duration of action of vecuronium in the elderly: comparison with adults. Acta Anaesthesiol Scand 1992; 36: 383–386.CrossRefGoogle ScholarPubMed
10.Matteo, RS, Ornstein, E, Schwartz, AE, Ostapkovich, N, Stone, JG. Pharmacokinetics and pharmacodynamics of rocuronium (Org 9426) in elderly surgical patients. Anesth Analg 1993; 77: 1193–1197.CrossRefGoogle ScholarPubMed
11.Bevan, DR, Fiset, P, Balendran, P, Law-Min, JC, Ratcliffe, A, Donati, F. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 1993; 40: 127–132.Google Scholar
12.Cope, TM, Hunter, JM. Selecting neuromuscular-blocking drugs for elderly patients. Drugs Aging 2003; 20: 125–140.Google Scholar
13.Bock, M, Klippel, K, Nitsche, B, Bach, A, Martin, E, Motsch, J. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia. Br J Anaesth 2000; 84: 43–47.CrossRefGoogle ScholarPubMed
14.Dragne, A, Varin, F, Plaud, B, Donati, F. Rocuronium pharmacokinetic–pharmacodynamic relationship under stable propofol or isoflurane anesthesia. Can J Anaesth 2002; 49: 353–360.CrossRefGoogle ScholarPubMed
15.Xue, FS, Liao, X, Tong, SY, Liu, JH, An, G, Luo, LK. Dose–response and time-course of the effect of rocuronium bromide during sevoflurane anaesthesia. Anaesthesia 1998; 53: 25–30.CrossRefGoogle ScholarPubMed
16.Slavov, V, Khalil, M, Merle, JC, Agostini, MM, Ruggier, R, Duvaldestin, P. Comparison of duration of neuromuscular blocking effect of atracurium and vecuronium in young and elderly patients. Br J Anaesth 1995; 74: 709–711.Google Scholar
17.Duvaldestin, P, Saada, J, Berger, JL, D’Hollander, A, Desmonts, JM. Pharmacokinetics, pharmacodynamics, and dose–response relationships of pancuronium in control and elderly subjects. Anesthesiology 1982; 56: 36–40.CrossRefGoogle ScholarPubMed
18.Booij, LHDJ. Neuromuscular transmission and its pharmacological blockade. Part 4: use of relaxants in paediatric and elderly patients, in obstetrics, and in the intensive care unit. Pharm World Sci 1997; 19: 45–52.Google Scholar
19.Frolkis, VV, Martynenko, OA, Zamostyan, VP. Aging of the neuromuscular apparatus. Gerontology 1976; 22: 244–279.Google Scholar
20.de Almeida, MC, Latorre, F, Gervais, HW, Kleeman, PP. The effects of age on onset and recovery from atracurium, rocuronium and vecuronium blockade. Anaesthesist 1996; 45: 903–906.CrossRefGoogle ScholarPubMed
21.Cooper, RA, Maddineni, VR, Mirakhur, RK, Wierda, JM, Brady, M, Fitzpatrick, KT. Time course of neuromuscular effects and pharmacokinetics of rocuronium bromide during isoflurane anaesthesia in patients with and without renal failure. Br J Anaesth 1993; 71: 222–226.Google Scholar
22.Khuenl-Brady, KS, Pomaroli, A, Pühringer, F, Mitterschiffthaler, G, Koller, J. The use of rocuronium in patients with chronic renal failure. Anaesthesia 1993; 48: 873–875.CrossRefGoogle ScholarPubMed
23.Cooper, RA, Mirakhur, RK, Wierda, JM, Maddineni, VR. Pharmacokinetics of rocuronium bromide in patients with and without renal failure. Eur J Anaesthesiol Suppl 1995; 11: 43–44.Google ScholarPubMed
24.Szenohradszky, J, Caldwell, JE, Sharma, ML, Gruenke, LD, Miller, RD. Interaction of rocuronium (ORG 9426) and phenytoin in a patient undergoing cadaver renal transplantation: a possible pharmacokinetic mechanism? Anesthesiology 1994; 80: 1167–1170.Google Scholar
25.Loan, PB, Connolly, FM, Mirakhur, RK, Kumar, N, Farling, P. Neuromuscular effects of rocuronium in patients receiving beta-adrenoreceptor blocking, calcium entry blocking and anticonvulsant drugs. Br J Anaesth 1997; 78: 90–91.Google Scholar
26.Rozen, MS, Whan, FM. Prolonged curarization associated with propranolol. Med J Aust 1972; 1: 467–468.CrossRefGoogle ScholarPubMed
27.Kawabata, K, Sumikawa, K, Kamibayashi, T et al. Decrease in vecuronium infusion dose requirements by nicardipine in humans. Anesth Analg 1994; 79: 1159–1164.CrossRefGoogle ScholarPubMed
28.Jones, RM, Cashman, JN, Casson, WR, Broadbent, MP. Verapamil potentiation of neuromuscular blockade: failure of reversal with neostigmine but prompt reversal with edrophonium. Anesth Analg 1985; 65: 1021–1025.Google Scholar
29.Salvador, A, del Pozo, E, Carlos, R, Baeyens, JM. Differential effects of calcium channel blocking agents on pancuronium and suxamethonium induced neuromuscular blockade. Br J Anaesth 1988; 60: 495–499.Google Scholar
30.Viby-Mogensen, J. Postoperative residual curarization and evidence-based anaesthesia. Br J Anaesth 2000; 84: 301–303.CrossRefGoogle ScholarPubMed
31.Murphy, GS, Szokol, JW, Marymont, JH, Franklin, M, Avram, MJ, Vender, JS. Residual paralysis at the time of tracheal extubation. Anesth Analg 2005; 100: 1840–1845.CrossRefGoogle ScholarPubMed