NMBA dosing in geriatric patients
Advanced, Clinical Subspecialties
Pharmacodynamics and pharmacokinetics both change with age:
- Smaller initial volume of distribution and lower muscle mass→ increased initial drug plasma concentration and longer period of drug effect
- Decreased liver and renal clearance → longer half-life
Prolonged metabolism of pancuronium and atracurium.
Vecuronium lower plasma clearance, due to decreased renal and hepatic reserve → prolonged action.
Cistrocurium unaffected by age since degradation is through Hoffman degradation.