Vecuronium in Alcoholic Liver Disease: A Pharmacokinetic and Pharmacodynamic Analysis

To determine the effect of alcoholic liver disease on the pharmacokinetics and pharmacodynamics of vecuronium, the authors administered vecuronium 0.1 mg ± kg iv to ten surgical patients with alcoholic liver disease and ten healthy surgical patients. All patients were anesthetized with nitrous oxide and isoflurane. We recorded and quantitated the force of thumb adduction in response to supramaximal ulnar nerve stimulation. Plasma concentrations of vecuronium and its 3-desacetyl metabolite were determined by a capillary gas chromatography assay. Only the time to attain 100% twitch ± depression (onset time) was prolonged in liver disease patients (2.8 ± 0.7 min; mean ± SD) as compared to control patients (1.9 ± 0.4 min). The time from vecuronium administration to recovery of twitch tension was unaffected by alcoholic liver disease. The time to the reappearance of twitch response was 32.7 ± 9.7 min in patients with liver disease and 36.8 ± 15.5 min in controls. Plasma concentration-time data were fit to two-compartment model. Vecuronium clearance, steady-state volume of distribution, and elimination half-time were unchanged by alcoholic liver disease. The authors conclude that alcoholic liver disease does not affect the pharmacokinetics or duration of action of vccuronium when an intravenou bolus dose of 0.1 mg ± kg is administered.