HEPATIC AND RENAL DISPOSITION OF PANCURONIUM AND GALLAMINE IN PATIENTS WITH EXTRAHEPATIC CHOLESTASIS

The plasma clearance of pancuronium in patients with extrahepaticcholestasis was 16% lower than in a control group (1.47±0.11ml min^–1 kg^–1 v. 1.76±0.21 ml min^–1kg^–1), but the difference was not significant. A significantincrease in the elimination half-life T^ß of pancuronium(from 141 to 224 min) and a significant increase in the volumeof the peripheral compartment (V₂ was found in patients withextrahepatic cholestasis when compared with control patients.There was a significantly lower cumulative biliary excretionof pancuronium (0.3±0.3% v. 10.9±3.2% in the controls)during the 48-h period of observation. The biotransformationand cumulative urinary excretion patterns of pancuronium revealedno significant differences between the two groups of patients.The increase of T^ß pancuronium in patients with extrahepaticcholestasis was mainly a consequence of the increase in thevolume of distribution. No significant differences in the plasmaclearance, T^ß or in the volume of distribution wereobserved with gallamine in the patients with extrahepatic cholestasiswhen compared with the control patients. The cumulative urinaryexcretion of gallamine during 48 h in both groups of patientswas approximately 100%. We concluded that in patients with cholestasisand normal glomerular filtration, gallamine is probably morereliable than pancuronium for neuromuscular blockade.