Rollino C, Visetti E, Borsa S, Pignataro A, Pozzato M, Vallero A, Quarello F
Division of Nephrology and Anaesthesiology,G. Bosco Hospital, Torino, Italy.
Artif Organs. 2000 May;24(5):386-7. doi: 10.1046/j.1525-1594.2000.06496.x.
Vecuronium is a curaric agent, largely used in anesthesia. Indications as to its employ in uremic patients appear to be debated because of partial renal elimination of the drug. A 52-year-old hemodialyzed woman required transplantectomy for rejection. At awakeness after general anesthesia (induced with fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min predilutional hemofiltration was then performed, which induced rapid disappearance of neuromuscular blockade. Even if vecuronium can be used in dialysis patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious use of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rapidly reversible with dialytic treatment.
维库溴铵是一种箭毒类药物，主要用于麻醉。由于该药物部分经肾脏排泄，其在尿毒症患者中的应用指征似乎存在争议。一名52岁接受血液透析的女性因移植肾排斥反应需要进行移植肾切除术。全身麻醉（用芬太尼、丙泊酚诱导，并给予6毫克维库溴铵，30分钟后单次追加2毫克）苏醒后，尽管给予了新斯的明，她仍出现膈肌和四肢肌肉无力，持续了180分钟。随后进行了2小时30分钟的预稀释血液滤过，这使得神经肌肉阻滞迅速消失。即使维库溴铵可用于透析患者，但在确定神经肌肉阻滞延长时，应记住其可能的副作用，尤其是重复给药时。在肾衰竭患者中必须谨慎使用该药物。必须采用低剂量并避免重复给药。透析治疗似乎可使神经肌肉阻滞迅速逆转。
