The Pharmacokinetics of d-Tubocurarine with Surgery Involving Salvaged Autologous Blood

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Abstract
The disposition of d-tubocurarine (dTc) was assessed when a bolus and infusion dosage regimen was used to obtain relaxation during major orthopedic surgery on the spine. Renal clearance of dTc was 0.63 .+-. 0.23 ml .cntdot. min-1 .cntdot. kg-1 and was correlated with creatinine clearance. Total plasma clearance of 1.21 .+-. 0.40 ml .cntdot. min-1 .cntdot. kg-1 was lower than that found in many previous studies, and the predetermined continuous dTc infusion produced an apparent plateau in plasma concentrations of 1.8 .+-. 0.3 .mu.g .cntdot. mg-1. Despite the operative blood loss, these concentrations were greater than anticipated and were associated with a more intense neuromuscular blockade than the infusion was designed to produce. Autologous blood transfusion was used to reduce the reliance on homologous donor blod, and the erythrocytes from the 2.2 .+-. 1.2 I of blood loss during the procedure were reinfused after intraoperative salvage, washing and centrifugation. With 80 .+-. 23 mg dTc administered, 1.4 .+-. 0.8% was recovered from the fluid discarded after centrifugation. Even massive intraoperative blood loss will not entail a significant reduction in the amount of dTc present in the body.