Antagonism of Atracurium-Induced Neuromuscular Blockade by Neostigmine or Edrophonium

Abstract

Antagonism of atracurium-induced neuromuscular blockade by neostigmine or edrophonium has been studied using the tetanic (50 Hz) and train-of-four (2 Hz) or single twitch responses of the adductor pollicis muscle in 22 anaesthetized patients. A further nine patients not given an anticholinesterase acted as a control group. In two groups (six patients for each anticholinesterase) in whom antagonism was attempted at 95-98% blockade of the tetanic response, recovery of the tetanic response after two or three doses of edrophonium 0.75 mg kg-1 i.v. was not statistically different from that in the control group; recovery after two doses of neostigmine 2.5 mg i.v. was significantly faster (P less than 0.001). Recovery of the single twitch response after antagonism with edrophonium, although longer than that with neostigmine (P less than 0.01), was significantly shorter than in the control group (P less than 0.05). When edrophonium is given at the commencement of recovery, the initial rapid antagonism of tetanic block is not sustained, whereas antagonism by neostigmine is more persistent and the recovery phase is significantly shortened. In a further two groups of patients (n = 5) given atracurium 0.3 mg kg-1 i.v., antagonism was not attempted until the peak height of the tetanic contraction had reached approximately 50% of the control value.(ABSTRACT TRUNCATED AT 250 WORDS)

Low and high frequency stimulation tests to characterize the effects of edrophonium on vecuronium-induced neuromuscular block

“…The purpose of this study was to characterize recovery of neuromuscular transmission 15 min after administration of edrophonium with different stimulation patterns, including low stimulation rates (twitch height (TH) 0.1 Hz train-of-four (TOF) 2 Hz) but also tetanic stimulations at 50 and 100 Hz. The use of high stimulation rates is desirable because of the limitations of low frequency stimulation rates for the detection of residual neuromuscular block in several clinical situations [16][17][18][19][20][21][22]. The second purpose was to study the effects of different doses of edrophonium given at various pre-reversal twitch heights on recovery of neuromuscular transmission.…”

Intraoperative Assessment of Atracurium-Induced Neuromuscular Block Using Double Burst Stimulation

“…The mean age of the 30 patients studied in group 2 was 45.3 yr (range 20-77 yr) with the male:female ratio 1:1.3. Data from this group indicated a median PTC when Dl was first palpated of 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

“…Identification of these points is of particular clinical value: a Tl/C value of less than 0.20-0.25 is compatible with adequate intraoperative relaxation when a volatile agent is used [9] and excellent conditions for tracheal intubation are present with a Tl/C value of less than 0.05 [10]. In addition, antagonism of atracuriuminduced paralysis may be accomplished reliably from this latter point in less than 9.6 min [11]. Nevertheless, despite limitations of sensitivity, palpation of a single response implies a Tl/C value < 0.20 and palpation of a double response a Tl/C value ^ 0.05 with a high degree of certainty.…”

Neostigmine and edrophonium for reversal of pipecuronium neuromuscular blockade

“…~-3'6'~1-18 In nine of these studies, edrophonium was compared directly with neostigmine. 1, 3,6,[13][14][15][16][17][18] From all studies one can conclude that for antagonism of neuromuscular blockade when T~ is 10% of control twitch tension or less, the dose of edrophonium should be I -1.5 mg. kg -I to be as rapid as neostigmine 0.04 mg. kg -~ . Nevertheless, Donati et al ~9 noted that the effect of the reversal agents is dependent on the relaxants, so that reversal of atracurium or vecuronium would be faster than that of pancuronium or dtubocurarine.…”