Characteristics of neuromuscular block after administration of rocuronium bromide in patients with end-stage renal failure

Abstract

Introduction. Anaesthesia affects kidney function by reducing the renal blood flow and glomerular filtration rate. As chronic renal failure (CRF) significantly influences drug metabolism and elimination, we studied the effects of rocuronium bromide (RB) in patients with CRF. Objective. The aim of the study was to examine whether, when using RB in patients with CFR, there are differences regarding the onset time of neuromuscular block (NMB) development, duration time, speed of recovery and cumulative effects of RB. Methods. Prospective study included 60 patients who underwent urologic surgery procedures. The patients were divided into 3 groups: the first group (G1) - 20 patients with CRF and residual dieresis, the second group (G2) - 20 patients with CRF and without dieresis, and third group (G3) - 20 patients with normal renal function (control group). During surgery RB was administrated for muscle paralysis in all patients. Train-of-four (TOF) Guard acceleromyography was used for NMB monitoring. Results. Onset time in three groups was 132.3 s; 139.5 s and 113.2 s (r<0.01). Duration of intubation dose was the same in G1 and G2 (28.9 minutes), while in the third group it was 27.2 minutes (r>0.05). The number of RB repeated doses was 3-8, 3-7 and 4-8 (r>0.05). The duration time until spontaneous recovery was 31.8, 31.6 and 29.8 minutes (r>0.01). The recovery index was 16.8, 16.7 and 10.6 minutes (r<0.001). The duration time from the last dose of RB to extubation was 74.5, 74.8 and 58.9 minutes (r<0.001). Conclusion. In patients with CRF the cumulative effect of the drug was registered, with a prolonged recovery time from NMB in relation to the patients with normal renal function.Uvod. Anestezija utice na funkciju bubrega tako sto smanjuje protok krvi kroz ove organe i glomerularnu filtraciju. Buduci da hronicna insuficijencija bubrega (HIB) znacajno utice na metabolizam i izlucivanje medikamenata, ispitivali smo efekte rokuronijum-bromida (RB) kod bolesnika sa HIB. Cilj rada. Cilj rada bio je da se utvrdi da li prilikom primene RB kod bolesnika sa HIB ima razlike u pogledu brzine nastanka neuromisicnog bloka (NMB), njegovog trajanja i brzine oporavka bolesnika, te da li postoje kumulativni efekti RB kod bolesnika sa HIB. Metode rada. Prospektivnom studijom obuhvaceno je 60 bolesnika operisanih zbog uroloskih indikacija, koji su svrstani u tri grupe od po 20 ispitanika. Prvu grupu cinili su bolesnici sa HIB i rezidualnom diurezom, drugu grupu bolesnici sa HIB bez diureze, a trecu (kontrolnu) grupu ispitanici normalne funkcije bubrega. Za relaksaciju misica tokom operacije svi bolesnici su primali RB. Za pracenje stanja NMB koriscena je tzv. train-of-four guard akceleromiografija. Rezultati. Brzina nastupanja NMB bila je 132,2 sekunde u prvoj, 139,5 sekundi u drugoj i 113,2 sekunde u trecoj grupi (r<0,01). Duzina dejstva intubacione doze bila je 28,9 minuta u prvoj i drugoj grupi, a 27,2 minuta u trecoj (r>0,05). Broj ponovljenih doza RB bio je 3-8 u prvoj, 3-7 u drugoj i 4-8 u trecoj grupi (r>0,05). Vremenski interval do spontanog oporavka bio je 31,8 minuta u prvoj, 31,6 minuta u drugoj i 29,8 minuta u trecoj grupi bolesnika (r>0,01). Indeks oporavka iznosio je 16,8, 16,7 i 10,6 minuta redom po grupama (r<0,001). Vreme od poslednje doze RB do ekstubacije bilo je 74,5, 74,8 i 58,9 minuta redom po grupama (r<0,001). Zakljucak. Kod bolesnika sa HIB beleze se kumulativni efekat i produzen oporavak od NMB u poredjenju sa ispitanicima cija je funkcija bubrega normalna.