Abstract
Eight trials comparing the effects of vecuronium in patients with either normal renal function or renal failure were subjected to a meta-analysis. Vecuronium doses were similar in the different trials, identical in the two patient groups of any given trial, and ranged from 0.05 to 0.14 mg· kg−1. Neuromuscular blockade was assessed by TOF or single twitch stimulation, and recorded by either mechanomyography or electromyography. Indices of blockade included onset time (from injection to maximal twitch depression), duration of action (from injection to recovery to 25% of control twitch) and 25–75% recovery index. Statistical analysis used Hedges method: effect size and variance were calculated for each relevant outcome, then the global effect size was estimated by pooling the effect sizes of each trial. Three separate meta-analyses were conducted. No differences were found either in onset time, or in recovery index between the two groups, whereas the duration of action was longer in the renal failure group. It is concluded that renal function is likely involved in the pharmacokinetic parameters of vecuronium.
Résumé
Huit études comparant les paramètres pharmacodynamiques du vécuronium dans deux populations, une à fonction rénale normale et l’autre en insuffisance rénale terminale, sont incluses dans une méta-analyse. Les posologies de vécuronium sont similaires entre les études, et identiques dans les deux populations de chaque étude. Le mode de stimulation est le train de quatre ou le single twitch, le monitorage est réalisé par mécanographie ou électromyographie. Les critères de jugement sont le délai d’action (de l’injection à la dépression maximale du twitch), la durée d’action (de l’injection à la récupération de 25% du twitch) et l’index de récupération 25–75. Les comparaisons statistiques utilisent la méthode de Hedges. Trois méta-analyses différentes sont réalisées, une par critère de jugement: aucune différence significative n’est mise en évidence entre les deux populations, ni pour le délai d’action, ni pour l’index de récupération. Par contre, la durée d’action est significativement allongée dans la population en insuffisance rénale. La fonction rénale joue donc probablement un rôle dans la pharmacocinétique du vécuronium.
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Beauvoir, C., Peray, P., Daures, J.P. et al. Pharmacodynamics of vecuronium in patients with and without renal failure: a meta-analysis. Can J Anaesth 40, 696–702 (1993). https://doi.org/10.1007/BF03009763
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DOI: https://doi.org/10.1007/BF03009763