DISPOSITION OF INFUSIONS OF ATRACURIUM AND ITS METABOLITE, LAUDANOSINE, IN PATIENTS IN RENAL AND RESPIRATORY FAILURE IN AN ITU |
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Authors: | PARKER, C. J. R. JONES, J.E. HUNTER, J. M. |
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Affiliation: | University Department of Anaesthesia Royal Liverpool Hospital, Prescot Street, P.O. Box 147, Liverpool L69 3BX |
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Abstract: | A study of plasma atracurium and laudanosine concentrationswas undertaken in 14 critically ill patients who received abolus dose of atracurium 0.6 mg kg1 followed by an infusionof 0.6mg kg1 h1 for a period of 1147 h.Seven of the patients had normal renal function and seven werein acute renal failure. In both groups plasma concentrationsof atracurium reached a plateau of approximately 1300 ng ml1within30 min of the bolus dose. The drug disappeared from the plasmawithin 120 min after discontinuation of the infusion. Therewas no difference between the two groups with respect to thepharmacokinetic parameters derived for atracurium. In the patientswith normal renal function, plasma laudanosine concentrationreached a plateau of apprpximately 1200ng ml1 within10h. In patients with renal failure there was a greater variationin the plasma laudanosine concentration: the highest value recordedwas 4300 ng ml1. Patients with renal failure had a significantlylonger mean elimination half-life for laudanosine (1418 minv. 375min; P < 0.05) and Vd (4.52 litre kg1 v. 240litre kg1; P < 0.01) than the patients with normalrenal function. *Present address: Southport General Hospital, Scarisbrick NewRoad, Southport, Merseyside PR8 6LF. |
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