| [ Summary ] |
The pharmacokinetics of volatile, local anesthetics are not altered in anephric patients. However, morphine and petidine may exert excessive and prolonged effects in patients with uremia, mainly due to the accumulation of active metabolites and decreased clearance, while the pharmacology of fentanyl is affected less significantly by renal failure. Hypnotic effects of intravenous anesthetics, including benzodiazepines and barbiturates, may be augmented through reduced protein-binding in anephric patients, though elimination profiles of these drugs are not influenced by renal failure. Among the neuromuscular blocking agents, pancuronium and d-tubocurarine exert more prolonged effects than vecuronium in uremic patients, because of their greater renal excression. Thus, although no anesthetic agents are contraindicated in anephric patients, some of them should be administrated to these patients with special cautions. |