BACKGROUND: Atracurium is eliminated by Hofmann elimination and ester hydrolysis, with minimal renal and hepatic excretion. Atracurium is not affected by renal function. Vecuronium is less dependent on the renal function than other steroid type neuromuscular blockers. But the action duration of vecuronium is prolonged in renal failure. The purpose of this study is to compare the differences of the effects of atracurium and vecuronium in patients with and without renal function.
METHODS: Forty patients with normal renal function and 40 patients with chronic renal failure were assigned to one of four groups: atracurium-normal(n=20), atracurium-renal failure(n=20), vecuronium- normal(n=20), vecuronium-renal failure(n=20). Anesthesia was induced with thiopental and maintained whith the inhalation of N2O(50%) and isoflurane(0.5-1.5vol%). Atracurium(0.5 mg/kg)or vecuronium (0.1mg/kg) was given as a muscle relaxants and then endotracheal intubation was performed after twitch response was depressed more than 80%. Neuromuscular blockade was assessed by TOF at the adductor pollicis with supramaximal stimulation of ulnar nerve of 2Hz every 12sec. The onset time, duration of 5, 25, 50, 75% recovery time and recovery index were recorded.
RESULTS: Onset of block was not different among four gorups. Recovery time of 5, 25, 50, 75% and recovery index were significantly longer in the both renal failure groups. Action durations in renal failure were not different between atracurium and vecuronium groups.
CONCLUSIONS: It is concluded that renal function is involved in action duration of atracurum and vecuronium. But there were no difference in action duration between the both relaxants in renal failure.
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