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Laudanosine, an atracurium and cisatracurium metabolite

Published online by Cambridge University Press:  16 August 2006

V. Fodale
Affiliation:
S. Vincenzo Cancer Medical Center and General Hospital, Department of Anesthesia Intensive Care Unit and Pain Therapy, Taormina
L. B. Santamaria
Affiliation:
University School of Medicine, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, Messina, Italy
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Abstract

Laudanosine is a metabolite of the neuromuscular-blocking drugs atracurium and cisatracurium with potentially toxic systemic effects. It crosses the blood-brain barrier and may cause excitement and seizure activity. Its interest in recent years has increased because of the recognized interaction with γ-aminobutyric acid, opioid and nicotinic acetylcholine receptors. It has been shown to produce analgesia in animals. In the cardiovascular system, high plasma concentrations produce hypotension and bradycardia. In hepatic failure, its elimination halflife is prolonged but only moderate accumulation occurs in adults, whereas in infants and children plasma concentration are greater. In patients undergoing liver transplantation, laudanosine concentrations are increased during preanhepatic, anhepatic and postanhepatic stages. Patients with renal failure have higher plasma concentrations and a longer mean elimination half-life. In pregnancy, laudanosine crosses the placental barrier. The mean transplacental transfer is 14% of maternal blood concentrations. Except for prolonged administration of atracurium in intensive care units, laudanosine accumulation and related toxicity seem unlikely to be achieved in clinical practice. When cisatracurium is used, plasma concentrations of laudanosine are lower. Further studies are needed, especially around the interactions with γ-aminobutyric acid, opioid and nicotinic acetylcholine receptors.

Type
Review
Copyright
2002 European Society of Anaesthesiology

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