NEUROMUSCULAR BLOCK WITH DOXACURIUM (BW A938U) IN PATIENTS WITH NORMAL OR ABSENT RENAL FUNCTION

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Abstract
The characteristics of neuromuscular block inducedby doxacurium were compared in patientswith and without renal function. Seventeenpatients with end stage chronic renal failure and18 patients with normal renal function were anaesthetized with 0.5% halothane and nitrousoxide in oxygen and received doxacurium in aninitial dose of 25 μg kg−1 (estimated from availabledata as an ED95 dose), with incremental doses of 5 μg kg−1. At the end of surgery, residualneuromuscular block was antagonized witheither edrophonium 1.0 mg kg−1 or neostigmine 0.08 mg kg−1. There was no significant difference between the mean maximum blocks achieved with doxacurium: 17.4% (renal failure group)and 11.6% (control group) of control twitch heights, or between the mean times to achieve maximum block (10.9 min and 10.8 min, respectively).The mean duration of action of doxacurium, indicated by the time for twitch height to recover to 25% of control, was longerin the renal failure group (120.8 min vs 66.7 minin the control group) (ns). Similarly, the meanduration of action of increments was longer inthe renal failure group (27.4 min vs 20.5 min inthe control group). The rate of spontaneous recovery from doxacurium as indicated by the time for twitch height to recover from 0 to 5%, 5 to 10% and 10 to 25%, was not significantly different in the two groups. Antagonism of doxacurium was achieved more reliably with neostigmine than with edrophonium in bothgroups. The administration of doxacurium was associated with minimal cardiovascular effects.