Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure

Purpose: To compare recovery parameters of total intravenous anesthesia (TIVA) with remifentanil and propofol, hemodynamic responses to perioperative events, and pharmacodynamic parameters of cisatracurium in 22 end-stage renal failure and 22 normal renal function patients. Methods: Anesthesia was induced with 2-3 mg.kg(-1) propofol and 1 mu g.kg(-1) remifentanil and maintained with 75 mu g.kg(-1).min(-1) propofol and propofol initial infusion of 0.2 mu g.kg(-1).min(-1) propofol. Arterial pressure and heart rate were maintained by remifentanil infusion rate adjustments. The first twitch (TI) was maintained at 25% by an infusion-of cisatracurium. Results: There was no difference in the time to maintenance of adequate respiration, date of birth recollection, first analgesic administration, between the renal failure (4.8 +/- 2.5, 7.8 +/- 3.2, 12.3 +/- 5.3 min respectively) and the control group (5.2 +/- 2.8, 8.1 +/- 3.1, 12.7 +/- 5.5 min): nor were there any differences in the time to 25% TI recovery, TI recovery from 25% to 75%, or cisatracurium infusion rate between the renal failure group (32.1 +/- 10.8 min, 18.2 +/- 5.5 min; 0.89 +/- 0.29 mu g.kg(-1).min(-1) respectively) and the control group (35.9 (7.9 min, 18.4 +/- 3.8 min, 0.95 +/- 0.22 mu g.kg(-1).min(-1)). Conclusion: End-stage renal failure does not prolong recovery from TIVA with remifentanil and propofol, or the recovery from cisatracurium neuromuscular block.