The Pharmacokinetics and Pharmacodynamics of Atracurium in Patients with and without Renal Failure

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Abstract
To determine the influence of renal function on the pharmacology of atracurium [a neuromuscular relaxant], 10 patients with normal renal function and 10 with renal failure (scheduled for cadaver kidney transplant) were anesthetized with N2O and halothane. Atracurium besylate, 0.5 mg .cntdot. kg-1, was given as an i.v. bolus and plasma samples were collected over a 4-h period. These samples were assayed for atracurium (all patients) and laudanosine, one of the principal metabolites (8 of the normal group), using an ion-exchange liquid chromatographic assay. The plasma concentrations of atracurium for each patient were fitted to a 2-compartment pharmacokinetic model. The onset time, duration of action, and recovery time of atracurium neuromuscular blockade were measured. There were no differences found in the pharmacokinetics or pharmacodynamics of atracurium between patients with normal renal function and those with renal failure. There were measureable levels of laudanosine following atracurium administration with peak levels of 199 .+-. 31 ng .cntdot. ml-1 at 2 min. The pharmacokinetics and pharmacodynamics of atracurium are apparently not altered by renal failure.