Pharmacodynamics of vecuronium in patients with and without renal failure: a meta-analysis

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.

Secondary hyperparathyroidism shortens the action of vecuronium in patients with chronic renal failure

“…This prolongation of the duration of action of vecuronium may be due to delayed elimination of vecuronium and its active metabolite (3-desacetylvecuronium) as reported by Lynam et al 5 Prolonged duration of action of vecuronium in CRF patients was also confirmed by a meta-analysis of eight clinical studies by Beauvoir et al 12 Our study showed that the duration of action of vecuronium in the anephric patients with severe hyperparathyroidism was shorter than in the patients with CRF who did not require parathyroidectomy. This result is inconsistent with the hypothesis that delayed renal elimination of vecuronium and its metabolite due to CRF may prolong the duration of action of vecuronium, became the renal elimination of vecuronium in anephric patients with severe hyperparathyroidism should be less than that in the CRF patients who did not need the haemodialysis therapy.…”

The Pharmacodynamics of Vecuronium in Chronic Renal Failure Patients: The Impact of Different Priming Doses

“…These results bear little relevance with the reports of Beauvoir and his associates. 38 In the current study, the prolonged duration of vecuronium was speculated to be due to delayed elimination of the drug. Changes in serum potassium and calcium were excluded because of their normal basal values.…”

Where's the Fire?

“…In our view, vecuronium is a perfectly acceptable choice in a patient with compromised renal function but normal hepatic function, who is undergoing a 1-2 h operation, where at most only a very modest prolongation of its neuromuscular blocking effects would be expected (6). Sedating patients in the recovery room and providing mechanical ventilatory support is not without significant attendant risks (e.g., agitation, main stem tracheal intubation, pneumothorax), as well as additional costs to the patient and the healthcare system.…”