The following are contraindicated in renal failure except:
Ans. D. Midazolam. (Ref. PauVs anaesthesia 5th/Pg. 254; Table 11-2; KDT 6th ed. 459)# With the exception of methoxyflurane and possibly enflurane, anesthtic agents do noy directly cause renal function or interfere with the normal compensatory mech activated by stress response.# Pancuronium. Clearance is decreased in renal and hepatic failure, demonstrating that excretion is dependent on bothOrgans........... Paul's anaesthesia 5th/pg. 435.# Pethidine: Nearly completely metabolized in liver. Acidification of urine increases excretion of unchanged pethidine. Renal failure patients given repeated doses of pethidine may experience effects of similar to that of its overdose - tremors, mydriasis, hyperreflexia, delirium, myoclonus, and convulsions............ KDT 6th ed. Pg. 459.# Midazolam: The hepatic clearance of IV anesthetics with a high (e.g., etomidate, propofol, ketamine) or intermediate (e.g., methohexital, midazolam) extraction ratio is largely dependent on hepatic blood flow, with most of the drug being removed from the blood as it flows through the liver (so- called perfusion-limited clearance). Midazolam undergoes extensive oxidation by hepatic enzymes to form water-soluble hydroxylated metabolites, which are excreted in the urine. The hepatic clearance rate of midazolam is five times greater than lorazepam and 10 times greater than diazepam. Although changes in liver blood flow can affect the clearance of midazolam, age has relatively little influence on midazolam's elimination half-life.......... Paul's anaesthesia 5th/pg. 338.Some Drugs with Significant Renal Excretion Encountered in Anesthesiology# Aminoglycosides# Quinolones# Cephalosporins# Digoxin# Procainamide# Atenolol# Edrophonium# Pyridostigmine# Nadolol# Neostigmine# Penicillins# Pancuronium# Doxacurium# Pipecuronium# Rocuronium# Enflurane6
Pancuronium
Pethidine
Enflurane
Midazolam
Muscle Relaxant