Atracurium infusions in patients with renal failure on an ITU

An infusion of atracurium was used (after an initial bolus dose) in five patients with renal and respiratory failure, who were being subjected to intermittent positive pressure ventilation before renal dialysis. Neuromuscular function was monitored by the train-of-four pattern of stimulation. In three patients, atracurium 0.6-0.7 mg/kg/hour completely abolished the twitch response; in the other two (both of whom were markedly oedematous) this did not occur, even with a dose of 1.0 mg/kg/hour, although satisfactory clinical control was obtained. In all patients, there was rapid spontaneous recovery when the infusion was stopped. One patient convulsed, but plasma laudanosine levels taken at this time were below the toxic range. Atracurium infusions appear to provide easily controllable neuromuscular blockade in the intensive therapy unit, although these preliminary results suggest that larger doses may be required in the oedematous patient.