Comparison of Intermittent Bolus and Continuous Infusion Techniques for Administration of Atracurium in Renal Failure

Introduction: Atracurium besylate is bisquaternary isoquinolinium compound, a potent non depolarizing muscle relaxant of intermediate duration. Its duration of action appears not to be prolonged in absence of normal renal function. Atracurium lacks cumulative effects and its shorter duration of action and rapid recovery from block suggest that Atracurium may be suitable for continuous intravenous infusion. Objectives: the present study was planned to compare effect of intermittent and intravenous infusion of atracurium in kidney diseases. Methods: Eighty patients scheduled for elective surgery were randomized into two groups: A and B. Their blood urea was > 80mg/dl, S.Creatinine >2mg%.Patients were assigned randomly to atracurium either as intermittent bolus(group A, n=40) or continuous infusion(group B, n=40). During induction phase each patient was given Inj. Propofol 1.5mg/kg I.V. and was paralysed with Inj.Atracurium 0.5mg/kg I.V. Various clinical parameters are monitored and compared. Results: In group A, the average pulse rate was 87.59±8.57mins with 9.78 percentage of intraoperative changes in pulse. While in group B the average pulse rate was 92.45±5.71mins with 6.18 percentage of intraoperative changes in pulse P = 0.002. No significant change was seen in blood pressure fluctuation. There is no significant difference in recovery time in either groups ( A : 11.1±2.2 and B : 11.4±2.6 min). The average total intraoperative dosage of atracurium in group A was 22.46±7.9 mg and the average total intraoperative dosage of atracurium in group B was 15.44±5.69 mg. (P = 0.0001). Conclusion: Intravenous continuous infusion is suitable alternative method of administration of atracurium in renal failure patients as it provides continuous adequate steady state of anaesthesia, stable haemodynamics and lesser intraoperative dosage requirement.