Changes in serum potassium following suxamethonium in the uraemic rat

Perioperative Pharmacologic Management of Patients with End Stage Renal Disease

The pharmacokinetics of numerous medications used in the perioperative period are altered in patients with end-stage renal disease. Clearance of drugs, or their metabolites, that are normally excreted by the kidney is markedly reduced in ESRD. In addition, patients with ESRD may also have alterations in gastrointestinal absorption, volume of distribution, protein binding, and metabolic clearance of pharmacologic agents. Finally, drug removal may be augmented during dialysis. All of these factors contribute to the need for dose adjustment of medications, including analgesics, anesthetics, neuromuscular blockers, and antimicrobial agents, which may be used in the perioperative management of the ESRD patient.

Emergencies in continuous dialysis patients: diagnosis and management

The number of patients undergoing long-term hemodialysis and peritoneal dialysis is growing in the United States. To provide adequate emergent care to these patients emergency physicians must understand the alterations in normal physiologies present in these patients and how this may affect care. Cardiovascular disease and infection (especially Staphylococcus aureus sepsis) are the leading causes of death among dialysis patients. These patients are also subject to a significantly higher incidence of life-threatening electrolyte disturbances, particularly hyperkalemia and hypercalcemia, than the general population. Suicide, cardiac tamponade, intracranial hemorrhage, bleeding disorders, and bowel infarction are also much more frequent. The inability of dialysis patients to excrete drugs, metabolites, toxins, and fluids significantly alters their responses to common emergencies and should directly influence their care. Failure to recognize these differences in physiology may result in the use of standard forms of emergency therapy that may compound, rather than treat, the underlying disorder. Although most dialysis patients who come into an emergency department have conditions that can, and should, be managed by their nephrologist, the presence of a life threatening emergency requires prompt, appropriate therapy by the emergency physician.

Suxamethonium and hyperkalaemia

Severe life-threatening hyperkalaemia may occur following administration of suxamethonium during certain periods after burns, neurological injuries, and in certain other conditions. Although this response is well-known, there is disagreement about when it may occur. This review describes the normal hyperkalaemic response to suxamethonium, the factors affecting it, the conditions in which it may be exaggerated, and the periods of high risk.

Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations

This retrospective study consisted of 500 consecutive renal transplantations performed between September 1977 and September 1981. Preoperatively, congestive heart failure was registered in 262 cases (53.0%) and blood pressure disease in 352 cases (71.3%). The total number of patients with ischaemic heart disease was 22 (4.5%). General anaesthesia was given in 493 and regional anaesthesia in seven cases. In general anaesthesias, tubocurarine was the main relaxant and halothane the main inhalation agent used. Major complications during anaesthesia were blood pressure changes with a higher incidence of hypotension (49.6%) than hypertension (26.8%). Severe cardiac arrhythmias were rare and no intraoperative deaths occurred. One patient was successfully resuscitated in the ICU postoperatively, this being possibly related to hypoventilation caused by prolonged muscular relaxation. Other rare complications included one pneumothorax, one haemo- and hydrothorax, and two large haematomas all caused by preoperative central venous cannulation. In 69 cases (14.0%) additional neostigmine doses and in 34 cases (6.9%) naloxone was given at the end of anaesthesia. Pneumonia during the first postoperative week was recorded in 11 cases (2.2%), and occurred only in patients who received general anaesthesia. One of the three patients who died during the first week developed pneumonia postoperatively.

Intubating conditions following pre-induction priming with alcuronium

Three priming doses of alcuronium have been investigated and, using a logistic transformation technique, the priming dose required to produce adequate intubating conditions in 99% of patients at 60 seconds following the second dose of alcuronium has been deduced. This dose, 106.5 micrograms/kg is extremely high and may be unsafe if used, since 30% of our patients complained of side effects when given a priming dose of only 50 micrograms/kg.

The influence of thiopentone and alfathesin on succinylcholine-induced fasciculations and myalgias

Thiopentone doses corresponding to 5.238 mg x kg-1, that is 2UD95 (UD95:unconsciousness dose 95) inhibit the intensity of succinylcholine-induced fasciculations compared with UD95. Alfathesin doses corresponding to 0.570 mg x kg-1, also 2UD95 (calculated as alphaxalone at a concentration of 9 mg/ml in alfathesin), do not have any greater effect on the degree of fasciculations compared to UD95. Furthermore, neither induction agent influences the incidence, distribution and duration of succinylcholine-induced myalgias. The inhibition of the degree of fasciculations caused by thiopentone is believed to be a consequence of a postsynaptic depressant effect of thiopentone at the neuromuscular junction. The evaluation of the degree of succinylcholine-induced fasciculations must take into consideration the dose of thiopentone administered at induction of anaesthesia.