British journal of anaesthesia
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To ascertain the effects of chronic renal failure on the pharmacokinetics of 1R-cis 1'R-cis atracurium besylate (a stereoisomer, designated 51W89), we gave a bolus dose of 0.1 mg kg-1 (2 x ED95) to 17 patients with end-stage renal failure and to 15 patients with normal renal function undergoing elective surgery. All patients received thiopentone, fentanyl and midazolam i.v. and 70% nitrous oxide in oxygen. Blood samples were obtained over 8 h and plasma analysed for 51W89 and laudanosine concentration, using high pressure liquid chromatography. ⋯ The typical value of T1/2 beta was 4.2 min longer in renal failure than in the healthy patients (34.2 vs 30.0 min, P < 0.005). In the healthy patients, clearance of 51W89 was greater in males, but it decreased with increasing age by approximately 1.5 ml min-1 yr-1. Mean plasma laudanosine concentrations were significantly higher in the renal failure group; nevertheless, they were approximately one-tenth of those reported after atracurium.
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Forty consecutive patients who could not be weaned from mechanical ventilation in the intensive care unit (ICU) entered a multidisciplinary progressive care programme (PCP). The mean number of hours per day of ventilatory support was 19.9 at the time of transfer but only 6.7 at discharge. ⋯ Seventy-six percent were alive 1 yr after discharge and 80% of patients were discharged directly from the PCP to their homes. Mental and emotional scores in a quality of life questionnaire (SF 36) were normal, but physical function remained limited.