Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000300004
Brazilian Journal of Anesthesiology
Scientific Article

Farmacodinâmica do cisatracúrio no transplante renal

Cisatracurium pharmacodynamics in renal transplantation

Ismar Lima Cavalcanti; Maria Angela Tardelli; Rita de Cássia Rodrigues

http://dx.doi.org/10.1590/S0034-70942002000300004 Braz J Anesthesiol, vol.52, n3, p.294-306, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A escolha do cisatracúrio, especialmente nos doentes com insuficiência orgânica, parece ser benéfica, devido a sua eliminação órgão independente de Hofmann e menor tendência a liberar histamina. Este trabalho tem como objetivo determinar, em doentes portadores de insuficiência renal crônica, a farmacodinâmica do cisatracúrio durante o transplante renal. MÉTODO: Foram estudados 30 pacientes divididos em dois grupos, 15 com função renal normal submetidos a cirurgia bucomaxilo-facial e 15 portadores de insuficiência renal crônica submetidos a transplante renal sob anestesia geral com etomidato, sufentanil e sevoflurano em concentrações entre 0,5 e 1% de fração expirada. Receberam dose venosa de 0,15 mg.kg-1 de cisatracúrio na indução e 0,05 mg.kg-1 todas as vezes que T1 recuperava 25%. A função neuromuscular foi monitorizada de forma contínua por aceleromiografia utilizando o padrão de estimulação seqüência de quatro estímulos, através da estimulação supramáxima do nervo ulnar. RESULTADOS: Os resultados referentes à farmacodinâmica do cisatracúrio mostram que o início de ação (4,1 e 4,9 min), a duração clínica (68,9 e 75,4 min) e o índice de recuperação (20,2 e 28 min) foram semelhantes entre os grupos normal e insuficiência renal, respectivamente. Os tempos para a relação T4/T1 atingir 0,7 (34,3 e 51,4 min) e 0,9 (49,7 e 68,6 min) a partir do último 25% de T1 apresentaram diferença estatisticamente significante entre os grupos, com os maiores valores no grupo insuficiência renal. A razão de acumulação foi igual a 1,08. CONCLUSÕES: O início de ação, a duração clínica e o índice de recuperação são semelhantes entre os dois grupos, o tempo para a relação T4/T1 atingir 0,7 ou 0,9 foi maior no grupo insuficiência renal do que no grupo normal e o cisatracúrio não apresentou efeito acumulativo no grupo insuficiência renal.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, CIRURGIA

Abstract

BACKGROUND AND OBJECTIVES: Cisatracurium seems to be beneficial, especially for patients with organ dysfunction, due to organ-independent Hofmann elimination and a lower trend to histamine release. This study aimed at determining cisatracurium pharmacodynamic profile in renal transplantation. METHODS: Participated in this study 30 patients who were distributed in two groups: 15 healthy patients submitted to maxillofacial surgery, and 15 patients with chronic renal failure submitted to renal transplantation. All patients were anesthetized with etomidate, sufentanil and 0.5% to 1% sevoflurane . Intravenous cisatracurium was administrated after anesthetic induction and additional 0.05 mg.kg-1 was injected whenever T1 recovered 25%. Neuromuscular function was continuously monitored by acceleromyography using TOF stimulation, through supramaximal ulnar nerve stimulation. RESULTS: Onset time (4.1 and 4.9 min), clinical duration (68.9 and 75.4 min) and recovery time (20.2 and 28 min) were similar between normal and renal failure groups, respectively. Time spent until T4/T1 > 0.7 (34.3 and 51.4 min), and > 0.9 (49.7 and 68.6 min) since the last 25% recovery of T1 were statistically different between groups, with the higher values observed in the renal failure group. Accumulation ratio was 1.08. CONCLUSIONS: Onset, clinical duration and recovery time were comparable between groups. Time to T4/T1 > 0.7 and > 0.9 was longer in the renal failure group as compared to the normal group and cisatracurium did not show cumulative effects in the renal failure group.

Keywords

NEUROMUSCULAR BLOCK, NEUROMUSCULAR BLOCK

References

Davidson AM, Cumming AD, Swainson PG. Diseases of the Kidney and Genito-Urinary System. Davidson's Principles and Practice of Medicine. 1995:611-668.

Sladen RN. Anesthetic Considerations for the Patient with Renal Failure. Anesthesiology Clinics of North America. 2000:863-882.

Sprung J, Kapural L, Bourke DL. Anesthesia for Kidney Transplant Surgery. Anesthesiology Clinics of North America. 2000;18:919-951.

Firestone L, Firestone S, Feiner JR. Organ Transplantation. Anesthesia. 2001:1973-2001.

Eastwood NB, Boyd AH, Parker JR. Pharmacokinetics of 1'R-cis atracurium besilate (51W89) and plasma laudanosine concentrations in health and chronic renal failure. Br J Anaesth. 1995;75:431-435.

Ortiz JR, Percaz JA, Carrascosa F. Cisatracurium. Rev Esp Anestesiol Reanim. 1998;45:242-247.

Kisor DF, Schmith VD. Clinical pharmacokinetics of cisatracurium besilate. Clin Pharmacokinet. 1996;36:27-40.

Viby-Mogensen J, Engbaec J, Erikson LI. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74.

Marin JS, Arañó JA, Miranda FG. Monitorización del Bloqueio Neuromuscular. Relajantes Musculares. 2000:107-120.

Doenicke AW, Czeslick E, Roizen MF. Does the induction agent influence the onset time of cisatracurium?: Etomidate vs propofol. Anesth Analg. 1999;88:S324.

Wulf H, Kahl M, Ledowski T. Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia. Br J Anaesth. 1998;80:308-312.

Boyd AL, Eastwood NB, Parker CJR. Pharmacodynamics of 1R cis-1'R cis isomer of atracurium (51W89) in health and chronic renal failure. Br J Anaesth. 1995;74:400-404.

Soukup J, Czeslick E, Bunk S. Cisatracurium bei patienten mit eingeschränkter nienrenfunction pharmakodynamik und intubationsbedingungen unter isofluran-lachgas-anästhesie. Anaesthesist. 1998;47:669-676.

Hunter JM, De Wolf A. pharmacodynamics and pharmacokinetics of cisatracurium in patients with renal or hepatic failure. Cur Op Anesthesiol. 1996;9:S42-S46.

Dahaba AA, Von Klobucar F, Rehak PH. Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure. Can J Anesth. 1999;46:696-700.

Hunter JM. Muscle relaxants in renal disease. Acta Anaesthesiol Scand. 1984;102(^sSuppl):2-5.

Savarese JJ, Deriaz H, Mellinghoff H. The pharmacodynamics of cisatracurium in healthy adults. Cur Opin Anaesthesiol. 1996;9:S16-S22.

Donati F. Onset of action of relaxants. Can J Anaesth. 1988;35:S52-S58.

Withington DE, Donati F, Bevan DR. Potentiation of atracurium neuromuscular blockade by enflurane: time-course of effect. Anesth Analg. 1991;72:469-473.

Melloni C, Antolini F. Effective doses of cisatracurium: Potentiation by sevoflurane and increasing requirements with age. Minerva Anestesiol. 2000;66:115-122.

Colvin MP, Savege TM, Newland PE. Cardiorespiratory changes following induction of anesthesia with etomidate in patients with cardiac disease. Br J Anaesth. 1979;51:551-556.

Criado A, Maseda J, Navarro E. Induction of anaesthesia with etomidate: haemodynamic study of 36 patients. Br J Anaesth. 1980:803-806.

Goodind JM, Corssen G. Effect of etomidate on the cardiovascular system. Anesth Analg. 1977;56:717-719.

Ali H, Savarese J. Stimulus frequency and dose-response curve to d-tubocurarine in man. Anesthesiology. 1980;52:36-39.

Ward S, Boheimer N, Weatherley BC. Pharmacokinetics of atracurium and its metabolites in patients with normal renal function, and in patients in renal failure. Br J Anaesth. 1987;59:697-706.

Belmont MR, Lien CA, Quessy S. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology. 1995;82:1139-1145.

Lepage JY, Malinovsky JM, Malinge M. Pharmacodynamic dose response and safety study of cisatracurium (51W89) in adult surgical patients during N2 O-O2-opioid anesthesia. Anesth Analg. 1996;83:823-829.

Marshall BE, Longnecker DE. General Anesthetics. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 1990:285-310.

Shanks CA. Pharmacokinetics of nondepolarizing neuromuscular relaxants applied to calculation of bolus and infusion dosage regimens. Anesthesiology. 1986;64:72-86.

Bozzo RB. Recuperación Espontânea y Revision Farmaco: lógica de los Relajantes Musculares. Relajantes Musculares. 2000:129-137.

Ornstein E, Lien CA, Matteo RS. Pharmacodynamics and pharmacokinetics of cisatracurium in geriatric surgical patients. Anesthesiology. 1996;84:520-525.

Viby-Mogensen J, Jorgensen BC, Ording H. Residual curarization in the recovery. Anesthesiology. 1979;50:539-541.

Lennmarken C, Löfstrôm JB. Partial curarization in the postoperative period. Acta Anaesthesiol Scand. 1984;28:260-262.

Beemer GH, Rozental P. Postoperative neuromuscular function. Anaesth Intensive Care. 1986;14:41-45.

Andersen BN, Madsen JV, Schurizek BA. Residual curarisation: a comparative study of atracurium and pancuronium. Acta Anaesthesiol Scand. 1988;32:79-81.

Bevan DR, Smith CE, Donati F. Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium and pancuronium. Anesthesiology. 1988;69:272-276.

Jensen E, Engbaek J, Andersen BN. The frequency of residual neuromuscular blockade following atracurium (A), vecurônio (V), and pancuronium (P): A multicenter randomized study. Anesthesiology. 1990;73:A913.

Brull SJ, Ehrenwerth J, Connelly NR. Assessment of residual curarization using low-current stimulation. Can J Anaesth. 1991;38:164-168.

Berg H, Viby-Mogensen J, Roed J. Residual neuromuscular block is a risk factor for postoperative pulmonary complications: A prospective, randomized, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41:1095-1103.

Viby-Mogensen J. Postoperative residual curarization and evidence-based anaesthesia. Br J Anaesth. 2000;84:301-303.

Baillard C, Gehan G, Reboul-Marty J. Residual curarization in the recovery room after vecuronium. Br J Anaesth. 2000;84:394-395.

Ali H, Wilson RS, Savarese JJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth. 1975;47:570-574.

Ali H, Savarese JJ, Lebowitz PW. Twitch, tetanus and train of four as indices of recovery from non depolarizing neuromuscular blockade. Anesthesiology. 1981;54:294-297.

Kopman AF, Yee PS, Neuman GG. Relationship of the train of four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86:765-771.

Eriksson LI, Lennmarken C, Wyon N. Attenuated ventilatory response to hipoxaemia at vecuronium induced partial neuromuscular block. Acta Anaesthesiol Scand. 1992;36:710-715.

Eriksson LI, Sato M, Severinghaus JW. Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response. Anesthesiology. 1993;78:693-699.

Eriksson LI, Sundman E, Olson R. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans. Anesthesiology. 1997;87:1035-1043.

Eriksson LI. The effects of residual neuromuscular blockade and volatile anesthetics on the control of ventilation. Anesth Analg. 1999;89:243-251.

Wright MC, Ornstein E. Pharmacokinetics, pharmacodinamics and safety of cisatracurium in elderly patients. Curr Opin Anaesth. 1996;9(^sSuppl 1):S32-S35.

Smith VD, Phillips L, Kisor DF. Pharmacikinetics/pharmacodynamics of cisatracurium in healthy adult patients. Curr Opin Anaesth. 1996;9(^sSuppl 1):S9-S15.

Bowman WB. Prejunctional and postjunctional cholinoceptors at the neuromuscular junction. Anesth Anag. 1980;59:935-943.

Nascimento DJ. Avaliação miográfica e eletrofisiológica dos efeitos farmacológicos do atracúrio na transmissão neuromuscular de rato. .

Ching LH. Bloqueadores neuromusculares: avaliação quantitativa dos efeitos diferenciais sobre contrações isoladas e tetânicas. .

Gramstad L, Gjerlow JA, Hysing ES. Interaction of cyclosporin and its solvent, cremofor, with atracurium and vecuronium. Br J Anaesth. 1986;58:1149-1155.

Sidi A, Kaplan RF, Davis RF. Prolonged neuromuscular blockade and ventilatory failure after renal transplantation and cyclosporine. Can J Anaesth. 1990;37:543-548.

Shima H. The effect of corticosteroids on the recovery from vecuronium induced block. Masui. 1990;39:619-625.

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