PHARMACODYNAMICS OF VECURONIUM IN PATIENTS WITH AND WITHOUT RENAL-FAILURE - A METAANALYSIS

Eight trials comparing the effects of vecuronium in patients with eith er normal renal function or renal failure were subjected to a meta-ana lysis. Vecuronium doses were similar in the different trials, identica l in the two patient groups of any given trial, and ranged from 0.05 t o 0.14 mg . kg-1. Neuromuscular blockade was assessed by TOF or single twitch stimulation, and recorded by either mechanomyography or electr omyography. Indices of blockade included onset time (from injection to maximal twitch depression), duration of action (from injection to rec overy to 25% of control twitch) and 25-75% recovery index. Statistical analysis used Hedges method. effect size and variance were calculated for each relevant outcome, then the global effect size was estimated by pooling the effect sizes of each trial. Three separate meta-analyse s were conducted. No differences were found either in onset time, or i n recovery index between the two groups, whereas the duration of actio n was longer in the renal failure group. It is concluded that renal fu nction is likely involved in the pharmacokinetic parameters of vecuron ium.