Cooper R A, Maddineni V R, Mirakhur R K, Wierda J M, Brady M, Fitzpatrick K T
Department of Anaesthetics, Queen's University of Belfast.
Br J Anaesth. 1993 Aug;71(2):222-6. doi: 10.1093/bja/71.2.222.
We have studied the onset and duration of action and pharmacokinetics of rocuronium bromide (Org 9426) during anaesthesia with nitrous oxide, fentanyl and isoflurane after a single bolus dose of rocuronium 0.6 mg kg-1 in nine patients with chronic renal failure requiring regular haemodialysis, and in nine healthy control patients. Blood samples were collected over 390 min and concentrations of rocuronium and its putative metabolites measured using HPLC. Onset time for maximum block, duration of clinical relaxation (T1(25)) and recovery index, were 61 (SD 25.0) s and 65 (16.4) s, 55 (26.9) min and 42 (9.3) min and 28 (12.3) min and 19 (8.8) min, respectively, for patients with and without renal failure. The time for TOF ratio to return spontaneously to 0.7 was 99 (41.1) min and 73 (24.2) min, respectively, in the two groups. None of these differences was significant. The pharmacokinetic data were best described by a three-exponential equation. There were significant differences between patients with and without renal failure in the rates of clearance (2.5 (1.1) ml kg-1 min-1 and 3.7 (1.4) ml kg-1 min-1, respectively) and the mean residence times (97.1 (48.7) min and 58.3 (9.6) min) P < 0.05). The differences in other kinetic parameters were not significant. We conclude that the effects of rocuronium may be prolonged in patients with renal disease, because of a decreased clearance of the drug.
我们在9例需要定期血液透析的慢性肾衰竭患者和9例健康对照患者中，研究了在氧化亚氮、芬太尼和异氟烷麻醉下，单次静脉注射0.6mg/kg罗库溴铵（Org 9426）后的起效时间、作用持续时间和药代动力学。在390分钟内采集血样，用高效液相色谱法测定罗库溴铵及其假定代谢产物的浓度。有和无肾衰竭患者的最大阻滞起效时间、临床松弛持续时间（T1(25)）和恢复指数分别为61（标准差25.0）秒和65（16.4）秒、55（26.9）分钟和42（9.3）分钟、28（12.3）分钟和19（8.8）分钟。两组中，肌颤搐比值自发恢复至0.7的时间分别为99（41.1）分钟和73（24.2）分钟。这些差异均无统计学意义。药代动力学数据用三指数方程拟合最佳。有和无肾衰竭患者在清除率（分别为2.5（1.1）ml·kg-1·min-1和3.7（1.4）ml·kg-1·min-1）和平均驻留时间（97.1（48.7）分钟和58.3（9.6）分钟）方面存在显著差异（P<0.05）。其他动力学参数的差异无统计学意义。我们得出结论，由于药物清除率降低，罗库溴铵在肾病患者中的作用可能会延长。
