Recovery of neuromuscular block after continuous infusion of cisatracuriumin patients with renal dysfunction.

Objective: Study of the recovery of neuromuscular block after continuous in fusion of cisatracurium in patients with renal dysfunction. Study design: Prospective case-control study. Patients: Forty adult patients scheduled for urological surgery were assign ed to two groups according to the creatinine clearance (CC) as a measure of the renal function: group IR (CC < 60 mL(.)min(-1)) or group NR (CC greate r than or equal to 60 ml(.)min(-1)). Methods:After premedication with hydroxyzine, anaesthesia was induced with propofol, sufentanil and cisatracurium (0.15 mg(.)kg(-1)), and maintained u sing isoflurane, sufentanil and a continuous infusion of cisatracurium (0.1 2 mg(.)kg(-1.)h(-1)) adjusted for maintained a post-tetanic count less than or equal to 5. Neuromuscular transmission was monitored at the adductor po llicis using accelerography (TOF Gard((R))). Onset and recovery times in bo th groups were compared using Student's t test. Results: infusion time and total dose of cisatracurium were comparable in b oth groups. Onset times were 3.9 +/- 0.8 min and 3.5 +/- 0.6 min in groups IR and NR respectively. After the infusion, the time to train-of-four ratio of 0.8 were not different in both groups : 77 +/- 18 min (group IR) and 73 +/- 13 min (group NR). However, the spontaneous recovery intervals 25 % - 75 % were delayed in group IR (20 +/- 9 min vs 14 +/- 5 min p < 0.05). Conclusion: There are minor differences in the pharmacodynamics of cisatrac urium between patients with normal or impaired renal function. Nevertheless , a marked interindividual variability in the recovery parameters was obser ved in patients with renal dysfunction. (C) 2001 Editions scientifiques et medicales Elsevier SAS.