Skip to main content
SpringerLink
Log in

Influence of renal and hepatic function on pharmacodynamics and pharmacokinetics of non-depolarizing muscle relaxants

  • Published:
Pharmaceutisch Weekblad Aims and scope Submit manuscript

Abstract

Liver and kidney function disturbances influence the pharmacodynamic and pharmacokinetic behaviour of drugs. Because of the differences in metabolism and excretion between the various muscle relaxants, liver and kidney disturbances do influence their pharmacodynamics and pharmacokinetics to a different extent. A description of the changes is given for the most frequently used non-depolarizing muscle relaxants. It is related to the practical clinical implications of the difference in the pharmacokinetics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Agoston SA, Crul JF, Kersten UW, Scaf AHJ. The relationship of the serum concentration of pancuronium to its neuromuscular activity in man. Anesthesiology 1977;47:509.

    Google Scholar 

  2. Shanks CA, Somogyi AA, Triggs EJ. Dose-response and plasma concentration-response relationships of pancuronium in man. Anesthesiology 1979;51:111–8.

    Google Scholar 

  3. Fairley HB. Prolonged intercortal paralysis due to a relaxant. Br Med J 1950;2:986.

    Google Scholar 

  4. Agoston S, Vermeer GA, Kersten UW, Scaf AHJ. A preliminary investigation of the renal and hepatic excretion of gallamine triethiodide in man. Br J Anaesth 1978;50:345–51.

    Google Scholar 

  5. Ramzan RJ, Shanks CA, Triggs EJ. Gallamine disposition in surgical patients with chronic renal failure. Br J Clin Pharmacol 1981;12:141–7.

    Google Scholar 

  6. Riordan DD, Gillentron AA. Prolonged curarisation in a patient with renal failure. Br J Anaesth 1971;43:506.

    Google Scholar 

  7. Miller RD, Matteo RS, Benet LZ, Solm YJ. The pharmacokinetics ofd-tubocurarine in man with and without renal failure. J Pharmacol Exp Ther 1977;202:1–7.

    Google Scholar 

  8. Orko R, Heino A, Rosenberg PH, Alanen T. Doseresponse of tubocurarine in patients with and without renal failure. Acta Anaesthesiol Scand 1984;28:452–6.

    Google Scholar 

  9. Camu F, d'Hollander AA. Neuromuscular blockade of fazadinium bromide (AH 8165) in renal failure patients. Acta Anaesthesiol Scand 1978;22:221–6.

    Google Scholar 

  10. Duvaldestin P, Bertrand JC, Concina D, Henzel D, Lareng L, Desmonts JM. Pharmacokinetics of fazadinium in patients with renal failure. Br J Anaesth 1979;51:943–7.

    Google Scholar 

  11. Bevan DK, D'Souza J, Rouse JM, Caldwell J, Smith RL. Clinical pharmacokinetics and pharmacodynamics of fazadinium in renal failure. Eur J Clin Pharmacol 1981;20:293–8.

    Google Scholar 

  12. Miller RD, Stevens WC, Way WL. The effect of renal failure and hyperkalaemia on the duration of pancuronium neuromuscular blockade in man. Anesth Analg 1973;52:661–6.

    Google Scholar 

  13. Agoston S, Vermeer GA, Kersten UW, Meijer DKF. The fate of pancuronium bromide in man. Acta Anaesthesiol Scand 1973;17:267–71.

    Google Scholar 

  14. McLeod K, Watson MJ, Rowlins MD. Pharmacokinetics of pancuronium in patients with noFmal and impaired renal function. Br J Anaesth 1976;48:341–5.

    Google Scholar 

  15. Buzello W, Agoston S. Pharmacokinetics of pancuronium in patients with normal and impaired renal function. Anaesthesist 1978;27:291–7.

    Google Scholar 

  16. Somogyi AA, Shanks CA, Triggs EJ. The effect of renal failure on the disposition and neuromuscular blocking action of pancuronium bromide. Eur J Clin Pharmacol 1977;12:23–9.

    Google Scholar 

  17. Agoston S, Crul JF, Kersten UW, Houwertjes MC, Scaf AHJ. The relationship between disposition and duration of action of congeneric series of steroidal neuromuscular blocking agents. Acta Anaesthesiol Scand 1977;21:24–30.

    Google Scholar 

  18. Fahey MR, Morris RB, Miller RD, Nguyen TL, Upton RA. Pharmacokinetics of Org NC 45 (norcuron) in patients with and without renal failure. Br J Anaesth 1981;53:1049–53.

    Google Scholar 

  19. Orko R, Heino A, Rosenberg PH. Vecuronium in patients with and without renal failure. Acta Anaesthesiol Scand 1985;29:326–9.

    Google Scholar 

  20. Hunter JM, Jones RS, Utting JE. Use of atracurium in patients with no renal function. Br J Anaesth 1982;54:1251–8.

    Google Scholar 

  21. Fahey MR, Rupp SM, Fisher DM, et al. The pharmacokinetics and pharmacodynamics of atracurium in patients with and without renal failure. Anesthesiology 1984;61:699–702.

    Google Scholar 

  22. Fahey MR, Rupp SM, Canfell C, et al. Effect of renal failure on laudanosine excretion in man. Br J Anaesth 1985:57:1049–51.

    Google Scholar 

  23. Wei-Zhong Shi, Fahey MR, Fisher DM, Miller RD, Canfell C, Eger II EI. Laudanosine (a metabolite of atracurium) increases the minimum alveolar concentration of halothane in rabbits. Anesthesiology 1985;63:584–8.

    Google Scholar 

  24. Hunter JM, Jones RS, Utting JE. Comparisons of vecuronium, atracurium and tubocurarine in normal patients and in patients with no renal function. Br J Anaesth 1984;56:941–51.

    Google Scholar 

  25. Booij LHDJ, Vree TB, Van der Pol F, Crul JF. Pharmacodynamics of vecuronium and pancuronium in cats with and without ligated renal pedicals. Acta Anaesthesiol Belg 1982;33:157–65.

    Google Scholar 

  26. Ramzan IM, Shanks CA, Triggs EJ. Pharmacokinetics and pharmacodynamics of gallamine triethiodide in patients with total biliary obstruction. Anesth Analg 1981;60:289–96.

    Google Scholar 

  27. Westra P, Vermeer GA, De Lange AR, Scaf AHJ, Meijer DKF, Wesseling H. Hepatic and renal disposition of pancuronium and gallamine in patients with extrahepatic cholestasis. Br J Anaesth 1981;53:331–8.

    Google Scholar 

  28. Westra P, Houwertjes MC, Wesseling H, Meijer DKF. Bile salts and neuromuscular blocking agents. Br J Anaesth 1981;53:407–15.

    Google Scholar 

  29. Dundee JW, Gray TC. Resistance tod-tubocurarine chloride in the presence of liver damage. Lancet 1953;2:16.

    Google Scholar 

  30. Duvaldestin P, Saada J, Henzel D, Saumon G. Fazadinium pharmacokinetics in patients with liver disease. Br J Anaesth 1980;52:789–94.

    Google Scholar 

  31. Ward ME, Adu-Gyansfi Y, Strunnin L. Althesin and pancuronium in chronic liver disease. Br J Anaesth 1975;47:1199.

    Google Scholar 

  32. Somogyi AA, Shanks CA, Triggs EJ. Disposition kinetics of pancuronium bromide in patients with total biliary obstruction. Br J Anaesth 1977;49:1103–8.

    Google Scholar 

  33. Duvaldestin P, Agoston S, Henzel D, Kersten UW, Desmonts JM. Pancuronium pharmacokinetics in patients with liver cirrhosis. Br J Anaesth 1978;50:1131–6.

    Google Scholar 

  34. Lebrault C, Berger JL, d'Hollander AA, Gomeni R, Henzel D, Duvaldestin P. Pharmacokinetics and pharmacodynamics of vecuronium in patients with cirrhosis. Anesthesiology 1985;62:601.

    Google Scholar 

  35. Leroy B, Baclet L, Sohnenfeld H, Scherpereel P. Atracurium et cirrhose: étude clinique de l'action curarisante. Ann F Anesth Reanim 1985;4:489–91.

    Google Scholar 

  36. Ward S, Neill EAM. Pharmacokinetics of atracurium in acute hepatic failure (with acute renal failure). Br J Anaesth 1983;55:1169–72.

    Google Scholar 

  37. Gyasi HK, Naguib M. Atracurium and severe hepatic disease: a case report. Can Anaesth Soc J 1985;32:161–4.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Free University Hospital, P.O. Box 7057, 1007, MB Amsterdam, The Netherlands

    L. H. D. J. Booij

Authors
  1. L. H. D. J. Booij
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Booij, L.H.D.J. Influence of renal and hepatic function on pharmacodynamics and pharmacokinetics of non-depolarizing muscle relaxants. Pharmaceutisch Weekblad Scientific Edition 9, 56–60 (1987). https://doi.org/10.1007/BF01960736

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01960736

Key words

Search

Navigation