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27 August 2024 : Review article  

Navigating Anesthesia: Muscle Relaxants and Reversal Agents in Patients with Renal Impairment

Paweł Radkowski ORCID logo123ABCDEFG, Karol Jan Krupiniewicz ORCID logo4ABCDEFG, Mariusz Suchcicki ORCID logo4ABCDEFG, Natalia Joanna Machoń ORCID logo4ABCDEFG, Sara Cappello ORCID logo5ABCDEFG, Maciej Szewczyk ORCID logo6ABCDEFG*, Joanna Maria Wolska ORCID logo7BCDE, Tomasz Stompór ORCID logo8ABCDEFG

DOI: 10.12659/MSM.945141

Med Sci Monit 2024; 30:e945141

Table 2 Impact of the clinical use of skeletal muscle relaxants depending on their route of elimination in reduced renal function.

DrugPath of elimination and metabolismClinical impact in impaired kidney function
RocuroniumExcretion by bile (70%), and in urine (10–5%)Decreased clearence and prolonged time of action
VecuroniumExcretion mainly by liver, active metabolite called 3-desacetyl vecuronium relies mainly on kidney elimination
PancuroniumExcretion by kidneys in 80%; hepatic degradation in 10% and biliary excretion in 10%; active metabolite excreted in major by kidneys
PipecuroniumExcretion mainly by kidneys. About 40% of pipecuronium is excreted unchanged by kidneys together with another 15% as 3-hydroxypipecuronium in 24 h
CisatracuriumMetabolized in liver through Hofmann elimination; metabolites are excreted primarily through the urine
MivacuriumMetabolized in liver through ester hydrolysis by plasma cholinesterase
AtracuriumMetabolized primarily in the liver, with minimal involvement of the kidneys in excretion
SuccinylcholinePlasma pseudocholinesterase

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750