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O'Connell MP, Stauber SD. Prolonged Neuromuscular Blockade From Continuous Vecuronium in an Infant With Renal Failure Being Treated With Dialysis. J Pediatr Pharmacol Ther 2022; 27:400-403. [PMID: 35558355 PMCID: PMC9088440 DOI: 10.5863/1551-6776-27.4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2023]
Abstract
Neuromuscular blockade may be required in critically ill pediatric patients to facilitate ventilator synchrony or maintain safety during high-risk procedures. Vecuronium is one neuromuscular blocking agent used for this purpose; however, there are limited data regarding its use in pediatric patients with renal failure. Although predominantly considered to be metabolized by the liver, there are numerous adult cases and 1 pediatric case report that have described extended paralysis from vecuronium due to renal failure. The proposed mechanism is accumulation of renally cleared active metabolites. This case report describes an infant with vecuronium exposure during continuous renal replacement therapy who experienced prolonged neuromuscular blockade for several days after the agent was stopped. This highlights the importance of considering renal function when selecting neuromuscular blocking agent.
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Affiliation(s)
| | - Sierra D Stauber
- Department of Pharmacy (SS), University of Rochester Medical Center, Rochester, NY
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Thompson A, Li F, Gross AK. Considerations for Medication Management and Anticoagulation During Continuous Renal Replacement Therapy. AACN Adv Crit Care 2017; 28:51-63. [PMID: 28254856 DOI: 10.4037/aacnacc2017386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Providing safe and high-quality care to critically ill patients receiving continuous renal replacement therapy (CRRT) includes adequate drug dosing and evaluation of patients' response to medications during therapy. Pharmacokinetic drug studies in acute kidney injury and CRRT are limited, considering the number of medications used in critical care. Therefore, it is important to understand the basic principles of drug clearance during CRRT by evaluating drug properties, CRRT modalities, and how they affect medication clearance. Few published studies have addressed drug disposition and clinical response during CRRT. Additionally, clotting in the CRRT circuit is a concern, so a few options for anticoagulation strategies are presented. This article reviews (1) the CRRT system and drug property factors that affect medication management, (2) the evidence available to guide drug dosing, and (3) anticoagulation strategies for critically ill patients receiving CRRT.
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Affiliation(s)
- Ashley Thompson
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
| | - Fanny Li
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
| | - A Kendall Gross
- Ashley Thompson is Critical Care Pharmacist, Senior Pharmacist Supervisor, University of California, San Francisco (UCSF) Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Ave. Box 0622, San Francisco, CA 94143 . Fanny Li is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Fran-cisco, California. A. Kendall Gross is Critical Care Pharmacist, UCSF Medical Center, and Health Sciences Assistant Clinical Professor, Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California
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