ANTAGONISM OF PANCURONIUM IN RENAL FAILURE: NO RECURARIZATION

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Abstract
Neuromuscular transmission was measured using train-of-4 stimulation, during and after anesthesia, in 20 patients with end-stage renal failure. Neuromuscular blockade was provided with pancouronium in single doses of either 3 or 6 mg/70 kg and antagonized at 10% recovery with atropine and neostigmine 2.5 mg/70 kg. Reversal was followed by progressive recovery of muscle twitch in every patient during the 3 h of the study. Recovery was more rapid after the smaller dose of pancuronium and was inversely correlated with the duration of blockade. When pancuronium is antagonized with neostigmine in patients with renal failure, neuromuscular transmission recovered without evidence of recurarization. When large doses of pancuronium are antagonized with neostigmine 2.5 mg, recovery may be insufficient to ensure normal ventilatory function.