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.


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Ali Kazemi, MD