HEPATIC AND RENAL DISPOSITION OF PANCURONIUM AND GALLAMINE IN PATIENTS WITH EXTRAHEPATIC CHOLESTASIS

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Abstract
The plasma clearance of pancuronium in patients with extrahepatic cholestasis was 16% lower than in a control group (1.47±0.11 ml min−1 kg−1v. 1.76±0.21 ml min−1 kg−1), but the difference was not significant. A significant increase in the elimination half-life T½β of pancuronium (from 141 to 224 min) and a significant increase in the volume of the peripheral compartment (V2 was found in patients with extrahepatic cholestasis when compared with control patients. There was a significantly lower cumulative biliary excretion of pancuronium (0.3±0.3% v. 10.9±3.2% in the controls) during the 48-h period of observation. The biotransformation and cumulative urinary excretion patterns of pancuronium revealed no significant differences between the two groups of patients. The increase of T½β pancuronium in patients with extrahepatic cholestasis was mainly a consequence of the increase in the volume of distribution. No significant differences in the plasma clearance, T½β or in the volume of distribution were observed with gallamine in the patients with extrahepatic cholestasis when compared with the control patients. The cumulative urinary excretion of gallamine during 48 h in both groups of patients was approximately 100%. We concluded that in patients with cholestasis and normal glomerular filtration, gallamine is probably more reliable than pancuronium for neuromuscular blockade.