Use of atracurium in patients with no renal function

Atracurium was given to 26 patients who had no renal function; in 21 of these neuromuscular block was monitored using the train-of-four stimuli. The results are compared with those obtained from normal patients presented for surgery. Unlike the non-depolarizing muscle relaxants currently in common use, it was possible to continue giving incremental doses of atracurium to the anephric patients without there being evidence of cumulation. Even when the total dose used (over a period of up to 2.5 h) was in the order of seven to eight times that previously described as the minimum required for endotracheal intubation (2.3 mg kg-1 as opposed to 0.3 mg kg-1), there was no evidence of residual curarization. This finding would seem to be compatible with that is known of the pharmacology of the drug. No adverse cardiovascular effects were demonstrated. It is concluded that atracurium may be especially valuable in patients with no renal function.