Department of Anesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland.
Department of Anesthesiology and Intensive Care, Regional Specialist Hospital, Olsztyn, Poland.
Med Sci Monit. 2024 Aug 27;30:e945141. doi: 10.12659/MSM.945141.
This comprehensive review explores the interaction between neuromuscular blocking agents, reversal agents, and renal function, focusing on various drugs commonly used in anesthesia and their effects on kidney health. Succinylcholine, commonly used for anesthesia induction, can trigger elevated potassium levels in patients with specific medical conditions, leading to serious cardiac complications. While studies suggest the use of succinylcholine in patients with renal failure is safe, cases of postoperative hyperkalemia warrant further investigation. Some agents, such as atracurium and mivacurium, are minimally affected by impaired kidney function, whereas others, such as cisatracurium and rocuronium, can have altered clearance, necessitating dose adjustments in patients with renal failure. The reversal agents neostigmine and sugammadex affect renal markers, while cystatin C levels remain relatively stable with sugammadex use, indicating its milder impact on glomerular function, compared with neostigmine. Notably, the combination of rocuronium and sugammadex in rat studies shows potential nephrotoxic effects, cautioning against the simultaneous use of these agents. In conclusion, understanding the interplay between neuromuscular blocking agents and renal function is crucial for optimizing patient care during anesthesia. While some agents can be used safely in patients with renal failure, others can require careful dosing and monitoring. Further research is needed to comprehensively assess the long-term impact of these agents on kidney health, especially in high-risk patient populations. This article aims to review the use of muscle relaxants and reversal for anesthesia in patients with impaired renal function.
这篇全面的综述探讨了神经肌肉阻断剂、逆转剂和肾功能之间的相互作用，重点关注麻醉中常用的各种药物及其对肾脏健康的影响。琥珀酰胆碱常用于麻醉诱导，可在特定疾病患者中引发血钾升高，导致严重的心脏并发症。虽然研究表明在肾衰竭患者中使用琥珀酰胆碱是安全的，但术后高钾血症的病例仍需要进一步研究。一些药物，如阿曲库铵和米库氯铵，受肾功能障碍的影响较小，而其他药物，如顺式阿曲库铵和罗库溴铵，则清除率改变，需要在肾衰竭患者中调整剂量。逆转剂新斯的明和舒更葡糖钠会影响肾脏标志物，而使用舒更葡糖钠时胱抑素 C 水平相对稳定，表明其对肾小球功能的影响较新斯的明更温和。值得注意的是，罗库溴铵和舒更葡糖钠在大鼠研究中的组合显示出潜在的肾毒性作用，因此不建议同时使用这些药物。总之，了解神经肌肉阻断剂与肾功能之间的相互作用对于优化麻醉期间的患者护理至关重要。虽然一些药物可在肾衰竭患者中安全使用，但其他药物可能需要谨慎剂量和监测。需要进一步研究来全面评估这些药物对肾脏健康的长期影响，特别是在高危患者群体中。本文旨在综述在肾功能受损患者中使用肌肉松弛剂和逆转剂进行麻醉的情况。
