Vecuronium and atracurium in patients with end-stage renal failure: A comparative study

Abstract

Twenty patients with end-stage renal failure, undergoing kidney transplantation, were assigned randomly to receive either vecuronium or atracurium under evoked twitch tension control. The cumulative-dose technique was used to obtain 95% twitch depression (vecuronium: initial bolus 15 μg kg-1, increments 6 μg kg-1; atracurium: initial bolus 100 μg kg-1, increments 40 μg kg-1). Using ED95 values derived from the log-probit dose-response curves, vecuronium was 4.6 times more potent than atracurium. The durations of action of the initial cumulativedoses (from end of injection of the last increment to 25% recovery) were 11.1± 3.3 min for vecuronium and 16.2±3.9 min for atracurium (P < 0.05). In terms of duration of action of the maintenance doses (vecuronium one-quarter of the total incremental dose; atracurium one-third) some cumulation was observed with vecuronium (interaction time x treatment; cumulation ratio 1.46 ±0.31 v. 0.98±0.10 for atracurium, P< 0.001). After 2 h of surgery, the mean recovery times (25% to 75% twitch height) did not differ (18.5±2.8 min and 16.7±4.4 min). It is concluded that vecuronium might be less safe than atracurium in patients with end-stage renal failure undergoing prolonged operations. © 1987 British Journal of Anaesthesia.