Does vecuronium accumulate in the renal transplant patient?

Abstract

Hunter et al. 1 compared vecuronium and atracurium in patients with normal and absent renal function undergoing a variety of surgical procedures. They found no difference between the two groups in duration of action of either drug and no evidence of accumulation. Fahey et al.2 compared the pharmacokinetics of vecuronium in patients with and without renal failure and found no significant difference in duration or evidence of accumulation between the two groups. Other authors 3'4 have demonstrated that atracurium showed no evidence of accumulation or prolongation of effect in the renal failure patient. However, some studies have shown prolongation of effect ~ and evidence of cumulation 6 with vecuronium in the anephric patient.Since vecuronium is a non-depolarizing relaxant which produces a neuromuscular blockade of short duration and without adverse cardiovascular effects, 2 it would seem ideal for the renal transplant patient. These patients frequently have accompanying multiple organ system disease and the procedure is one during which hypotension can have markedly adverse effects. While the muscle relaxant properties of atracurium and its lack of dependence on renal clearance for elimination make it seem useful for the transplant population, its possible histamine release with concomitant hypotension 7 could limit its use in this group. The purpose of this study is to compare the neuromuscular effects of atracurium and veeuronium in the cadaver renal transplant patient.

Anaesthesia for renal transplantation in sickle cell disease

“…50 Vecuronium is eliminated by renal and extra-renal factors and whilst some reports indicate that its duration of action is little affected by renal dysfunction, 5~ others suggest the possibility of accumulation with large doses. [52][53][54] Atracurium would seem to be the relaxant of choice because its metabolism is independent of the kidney or the liver and the duration of action is the same in patients with or without renal disease. 55'56 The use of a continuous infusion provides a constant level of neuromuscular block for prolonged periods which is easily reversed at the end of surgery, s7 Clearance of laudanosine, a metabolite of atracurium with cerebral irritant effects, is not affected by renal failure, s6's8 The neuromuscular junction must be monitored whenever vecuronium or atracurium is used.…”