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Alcuronium kinetics in patients undergoing cardiopulmonary bypass surgery.
Author(s) -
Walker JS,
Brown KF,
Shanks CA
Publication year - 1983
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.1983.tb01492.x
Subject(s) - cardiopulmonary bypass , anesthesia , pharmacokinetics , extracorporeal circulation , medicine , volume of distribution , bolus (digestion) , extracorporeal , intravenous bolus , cardiac surgery , surgery , pharmacology
1 The disposition of alcuronium was investigated in 10 patients undergoing surgery involving cardiopulmonary bypass (CPB) and compared with results from a group of non‐cardiac patients studied previously. 2 After intravenous administration of a combined bolus and infusion dosage regimen, plasma concentrations fell in a bi‐exponential fashion to a mean value of 0.55 micrograms/ml immediately before the start of extracorporeal circulation. 3 During CPB an apparent steady‐state of alcuronium was reached immediately after commencement of CPB, however plasma concentrations were some 50% higher than those noted prior to commencement of CPB and those predicted using previous pharmacokinetic data from normal surgical patients. 4 Once CPB was completed and the alcuronium infusion terminated, post‐infusion alcuronium plasma concentrations again appeared to decline bi‐exponentially with time. 5 Of the pharmacokinetic parameters which were calculated model‐ independently, the apparent volume of distribution (Vss) was unchanged (329 vs 313 ml/kg) and the elimination half‐life (t1/2,z) (532 vs 199 min) was prolonged and the plasma clearance (CL) (0.8 vs 1.34 ml min‐ 1kg‐1) markedly reduced in these patients compared to non‐cardiac surgical patients. 6 As a result of these changes in alcuronium concentration during CPB and the diminished elimination of alcuronium following CPB, a closer monitoring of neuromuscular function may be necessary in cardiac patients undergoing CPB.