HEPATIC AND RENAL DISPOSITION OF PANCURONIUM AND GALLAMINE IN PATIENTS WITH EXTRAHEPATIC CHOLESTASIS |
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Authors: | WESTRA, P. VERMEER, G. A. DE LANGE, A. R. SCAF, A. H. J. MEIJER, D. K. F. WESSELING, H. |
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Affiliation: | Research Group of the Institutes of Ansesthesiology and Clinical Pharmacology, State University of Groningen Bloemsingel 1, 9713 BZ Groningen, the Netherlands Department of Pharmacology and Clinical Pharmacology, State University of Groningen Bloemsingel 1, 9713 BZ Groningen, the Netherlands Department of Pharmacology and Clinical Pharmacology, and Department of Pharmacy, State University of Groningen Bloemsingel 1, 9713 BZ Groningen, the Netherlands |
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Abstract: | The plasma clearance of pancuronium in patients with extrahepaticcholestasis was 16% lower than in a control group (1.47±0.11ml min1 kg1 v. 1.76±0.21 ml min1kg1), but the difference was not significant. A significantincrease in the elimination half-life Tß 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 Tß pancuronium in patients with extrahepaticcholestasis was mainly a consequence of the increase in thevolume of distribution. No significant differences in the plasmaclearance, Tß 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. |
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