Comparative evaluation of neuro-muscular blockade after pancuronium administration in patients with and without renal...

Objective studies about the duration of action pancuronium (PCM) in renal failure patients are scarce. This study was undertaken to obtain more complete information on spontaneous reversal from PCM-induced neuromuscular block by monitoring the twitch height to full recovery in the absence of any potentiating agent. Thumb abduction was monitored by a deplacement transducer in end-stage renal failure (ESRF) and in control patients without renal failure (RF) during neuroleptanalgesia after 0.04 mg/kg and 0.08 mg/kg PCM administration. In the small dosage series, the prologation of action in ESRF becomes significant for the 75% recovery level (mean values +/- s.e.mean:control: 42 +/- 7 min, ESRF: 71 +/- 10 min, P less than or equal to 0.05). In the second series (0.08 mg/kg), the 50% recovery level is already significantly delayed in ESRF patients (control: 91 +/- 7 min, ESRF: 163 +/- 27 min, P less than or equal to 0.05). The 100% twitch height recovery is obtained with 0.04 mg/kg PCM within 65+/- 7 min for patients without RF and within 103 +/- 9 min in ESRF patients (P less than or equal to 0.01). For the 0.08 mg/kg PCM dose, these figures are, respectively, 139 +/- 9 min and 214 +/- 20 min (P less than or equal to 0.01). The prolongation of PCM action in ESRF is in agreement with the pharmaco-kinetics of the drug. Large dosages of PCM must be avoided in ESRF patients because it delays spontaneous full recovery for too long.