Vecuronium infusions in patients with renal failure in an ITU

The use of an infusion of vecuronium is described in seven patients with renal and respiratory failure in an intensive therapy unit. Neuromuscular function was monitored throughout using the train-of-four twitch technique. A bolus dose of vecuronium (0.1 mg/kg) was given, followed immediately by a continuous infusion (0.05 mg/kg/hour). The infusion rate was adjusted until the first twitch of the train was below 20% of control and then run at a constant rate. There was a marked variation in the dose of vecuronium administered (0.01-0.065 mg/kg/hour [corrected]). Two patients, who appeared to be most sensitive to the drug, were both receiving metronidazole. Recovery of neuromuscular function was extremely prolonged and widely variable (6-37 hours) on stopping the infusion. No adverse cardiovascular effects or evidence of histamine release were seen as a result of administration of the drug. Vecuronium is probably more suitable for administration in bolus doses rather than by infusion in patients with renal and respiratory failure.