thiopental and Kidney-Failure--Chronic

According to literature data Atracurium besylate is a nondepolarizing muscle relaxant akin to the "ideal", insofar as it is governed by the "dose-relaxation time" principle. To secure normal clinical effect, doses in the range 0.4-0.5 mg/kg body mass are recommended, with the maximal manifestation of neuromuscular block occurring within 4.6-7.7 min, and lasting for 35.1 to 39.2 minutes. Maintenance dose: 0.05-0.1 mg/kg body mass. Special emphasis is laid on the fact that at normal temperature and pH the dose/relaxation time ratio is strictly fixed which in turn renders relaxation readily controllable. For the purpose a special table is submitted by the producers (Wellcome Company). As it is well known Atracurium splitting runs a course by the so-called Hoffmann reaction, requiring normal pH and temperature. Atracurium is administered to ten chronic renal failure patients in the course of kidney transplantation, abiding to all requirements and doses recommended by the company. A significant muscle relaxation with virtually twice as long duration (35-101 min) is noted, attributable to the presence of metabolic acidosis ("0.605), interfering with the normal course of the Hoffmann reaction for Atracurium disintegration. In the genesis of the phenomena observed any central mechanisms, e.g. hyperventilation, overdosage of the anesthetic, hypothermia and the like, are ruled out. In patients with acidosis it is advised to handle the muscle relaxant with greater caution.

Topics: Anesthetics, Intravenous; Atracurium; Humans; Kidney Failure, Chronic; Kidney Transplantation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Preanesthetic Medication; Propofol; Thiopental; Time Factors

Thiopental kinetics and protein binding were determined in seven surgical patients with chronic renal failure and a thiopental free fraction of 28.0 +/- 6.5% (SD) and in seven age- and weight-matched normal surgical patients with a thiopental free fraction of 15.7 +/- 2.4%. Thiopental clearance, based upon total plasma concentrations, rose from 3.2 +/- 0.6 ml/kg/min in the normal group to 4.5 +/- 1.1 ml/kg/min in the chronic renal failure group. Volume of distribution at steady state, also based on total drug concentrations, rose from 1.9 +/- 0.5 l/kg in the normal group to 3.0 +/- 1.0 l/kg in the chronic renal failure group. These changes in clearance and volume of distribution at steady state are secondary to changes in free drug distribution and elimination. When kinetics were calculated from free drug concentrations, the intrinsic clearance, unbound volume of distribution at steady state, and free fraction in tissues in the normal and renal failure groups did not differ substantially. These data suggest that the kinetic changes based on total drug concentrations are secondary to changes in free fraction in plasma. In chronic renal failure patients, the underlying rate and extent of thiopental distribution and elimination are much the same as in normal patients.

Topics: Blood Proteins; Humans; Kidney Failure, Chronic; Kinetics; Male; Middle Aged; Protein Binding; Thiopental

Topics: Acidosis; Acute Kidney Injury; Anemia; Anesthesia; Anesthesia, Epidural; Anesthesia, Spinal; Antihypertensive Agents; Arrhythmias, Cardiac; Heart Failure; Hepatitis; Humans; Hyperkalemia; Hypertension; Hypocalcemia; Hyponatremia; Kidney Failure, Chronic; Nausea; Preanesthetic Medication; Seizures; Thiopental; Uremia; Vomiting

Topics: Adolescent; Adult; Anesthesia, General; Child; Cyclopropanes; Female; Halothane; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Nephrectomy; Preanesthetic Medication; Splenectomy; Succinylcholine; Thiopental; Transplantation Immunology; Transplantation, Homologous