The Antagonism Effects of Neostigmine on Vecuronium - induced Neuromuscular Blockade in Renal Failure Patients

Han, Jeong Seon; Shin, Yang Sik; Nam, Soon Ho; Moon, Bong Gi; Park, Kwang Won

Abstract

The elimination of most anticholinesterases depends on the kidney, even if the main organ for their metabolism is the liver. Renal excretion of pyridostigmine, edrophonium and neostigmine accounts for 15%, 70% and 50%, respectively. In the absence of renal function, the serum half-life of neostigmine is prolonged, its plasma clearance is decreased However, the pharmacodynamics of neostigmine have not been determined in renal failure. This study was designed to compare the neostigmine dynamics in 18 patients with normal renal function to that in 18 patients with renal failure(Group I & II, respectively). Using the flexor carpi ulnaris EMG via ulnar nerve stimulation with Train-Of-Four(TOF) under the constant infusion of vecuronium to produce about 85%-twitch depression, the responses of neostigmine with three different doses were obtained. The results are follows; 1) The constant infusion rates of vecuronium to maintain sbout 15&-twitch height prior to the administration of neostigmine showed no significant difference between two groups. 2) Immediately prior to each dose of neostigmine, the mean values of twitch heights were 11.7 to 13.7%. 3) There was no significant difference in the onset time, maximum twitch responses and antagonism effects between two groups in respect to each same dose of nesotigmine. 4) The duration of neostigmine with the half of ED only in Group II was significantly longer than that in Group I, even if the durations with the other doses in Group II were not significantly longer than those in Group L These results suggest that the reversal effect of neostigmine to vecuronium-induced block- ade may be outlasted in patients with renal failure and the prolongation of neostigmine effeet may render some benefits to reverse the relaxants which have the limitation of its elimination in this patients.