Gallamine disposition in surgical patients with chronic renal failure.

Ramzan, M. I.; Shanks, Colin A.; Triggs, E. J.

doi:10.1111/j.1365-2125.1981.tb01192.x

Cited by 37 publications

(2 citation statements)

References 24 publications

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“…The duration of action of certain neuromuscular blockers can be prolonged in patients with renal failure as the result of reduced renal elimination of the drug or active metabolites and reduced acetylcholinesterase activity, which accompanies renal failure. Gallamine, metocurine, pancuronium, rocuronium, pipecuronium, doxacurium, and d-tubocurarine are predominately eliminated by the kidney and have longer, more variable duration of action in patients with renal failure (34)(35)(36)(37)(38)(39). Mivacuronium is metabolized by actelycholinesterases, which also results in a longer duration of action in renal failure (40).…”

Section: Neuromuscular Blocking Agentsmentioning

confidence: 99%

Perioperative Pharmacologic Management of Patients with End Stage Renal Disease

Karambelkar

Kasekar

Palevsky

2015

Seminars in Dialysis

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The pharmacokinetics of numerous medications used in the perioperative period are altered in patients with end-stage renal disease. Clearance of drugs, or their metabolites, that are normally excreted by the kidney is markedly reduced in ESRD. In addition, patients with ESRD may also have alterations in gastrointestinal absorption, volume of distribution, protein binding, and metabolic clearance of pharmacologic agents. Finally, drug removal may be augmented during dialysis. All of these factors contribute to the need for dose adjustment of medications, including analgesics, anesthetics, neuromuscular blockers, and antimicrobial agents, which may be used in the perioperative management of the ESRD patient.

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Section: Neuromuscular Blocking Agentsmentioning

confidence: 99%

Perioperative Pharmacologic Management of Patients with End Stage Renal Disease

Karambelkar

Kasekar

Palevsky

2015

Seminars in Dialysis

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“…However, the successful use of low doses of gallamine in patients with renal failure has been cited (White et al 1971). Ramzan et al (1981b) showed the elimination half-life of gallamine to be greatly prolonged from 2.2 in healthy patients to 12.5 in patients with renal failure and this change was due to a decrease in plasma clearance. Ramzan et al (1981b) showed the elimination half-life of gallamine to be greatly prolonged from 2.2 in healthy patients to 12.5 in patients with renal failure and this change was due to a decrease in plasma clearance.…”

Section: Gallaminementioning

confidence: 99%

Muscle Relaxants

1995

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Originally published by Springer-Verlag Tokyo in 1995. Softcover reprint ofthe hardcover lst edition 1995 This work is subject to copyright. AII rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of iIIustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and st<;>rage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Iiability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceuticalliterature. PrefaceThe Fifth International Neuromuscular Meeting was held in Tokyo from November 17 through 20, 1994, and it was my privilege to chair these proceedings. It might seem to some that everything that can be said about the pharmacology of neuromuscular blocking agents (NBA) and their antagonists, the clinical use of NBAs, and the anatomy and physiology of neuromuscular receptor sites has already been said. From the beginning of the meeting, it became clear, not surprisingly, that such is not the case.It was a tortuous path from the first recorded clinical use of a curariform substance by Lawen in 1912 to the introduction of Intocostrin by Griffith in Canada, as reported in a 1942 issue of Anesthesiology. The practice of anesthesiology and surgery was changed forever. It was to be many years before a clear understanding of the neuromuscular junction (NMJ) and receptor pharmacology emerged. Prejunctional and post junctional actions of NBAs can now be differentiated and these data are clearly presented in these proceedings. The effects of catecholamine stress, burns, immobilization, and endotoxicosis as well as those from chronic infusions of curare and succinylcholine on NMJ pertubations have been elucidated. Recent studies utilizing the tools of molecular biology have helped to explain both prolonged blockade and sudden, lethal hyperkalemia following the administration of succinylcholine.Special considerations are addressed for administering NBAs to children, the elderly, and those with impaired renal and hepatic function. The relationship between the pharmacokinetics of d-Tubocurarine (dTc) , vecuronium, and atracurium and the volume of distribution in children is discussed, as is the decreased prejunctional acetylcholine stores in neonates and infants. In the elderly, elimination of NBAs (except for atracurium and, possibly, pipecuronium) is delayed due to decreased plasma clearance. In this respect, atracurium is unique since its half-life is independent of either renal or hepatic function. Elimination pathways of the new steroidal NBAs have not been established. The reader will be reminded, however, that the influence of hepatic disease ...

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Relationship Between Gallamine Plasma Concentration and Neuromuscular Paralysis in Surgical Patients

Ramzan

Shanks

Triggs

1983

The Journal of Clinical Pharma

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The pharmacodynamics of the neuromuscular blocking drug gallamine were investigated in 10 surgical patients using a constant-rate infusion regimen, and results are compared to those for d-tubocurarine (dTc). Gallamine effect (paralysis)-time data gathered during and following the infusion were fitted to a pharmacodynamic effect model, while paralysis-plasma concentration data gathered during (onset) and following (offset) the infusion were fitted separately to a nonlinear form of the Hill equation. The effect model was most appropriate in characterizing the combined (on and off infusion) effect data. While there was also an excellent characterization of onset and offset data with the Hill equation, the two effect-concentration curves were not superimposable. The mean (+/- S.D.) plasma concentration of gallamine at 50 per cent paralysis during onset of action (Cp50(onset) 8.0 +/- 1.8 micrograms/ml) or that predicted to exist at steady state using the effect model (Cp50(ss) 5.4 +/- 1.4 micrograms/ml). Cp50(offset) and Cp50(ss) did not differ significantly, and there was no significant difference in the power factor (lambda) estimates for the various model fits. Comparison of the pharmacodynamic parameters for gallamine and dTc using the effect model revealed no significant differences in keo, t1/2(keo), and lambda estimates. However, Cp50(ss) for gallamine (5.4 +/- 1.4 micrograms/ml) was nine times higher than that for dTc (0.61 +/- 0.15 micrograms/ml) in absolute terms and seven times higher when compared on a molar basis.

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Gallamine disposition in surgical patients with chronic renal failure.

Cited by 37 publications

References 24 publications

Perioperative Pharmacologic Management of Patients with End Stage Renal Disease

Perioperative Pharmacologic Management of Patients with End Stage Renal Disease

Muscle Relaxants

Relationship Between Gallamine Plasma Concentration and Neuromuscular Paralysis in Surgical Patients

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