27 August 2024 : Review article
Navigating Anesthesia: Muscle Relaxants and Reversal Agents in Patients with Renal Impairment
Paweł RadkowskiDOI: 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.
| Drug | Path of elimination and metabolism | Clinical impact in impaired kidney function |
|---|---|---|
| Rocuronium | Excretion by bile (70%), and in urine (10–5%) | Decreased clearence and prolonged time of action |
| Vecuronium | Excretion mainly by liver, active metabolite called 3-desacetyl vecuronium relies mainly on kidney elimination | |
| Pancuronium | Excretion by kidneys in 80%; hepatic degradation in 10% and biliary excretion in 10%; active metabolite excreted in major by kidneys | |
| Pipecuronium | Excretion mainly by kidneys. About 40% of pipecuronium is excreted unchanged by kidneys together with another 15% as 3-hydroxypipecuronium in 24 h | |
| Cisatracurium | Metabolized in liver through Hofmann elimination; metabolites are excreted primarily through the urine | |
| Mivacurium | Metabolized in liver through ester hydrolysis by plasma cholinesterase | |
| Atracurium | Metabolized primarily in the liver, with minimal involvement of the kidneys in excretion | |
| Succinylcholine | Plasma pseudocholinesterase |






