Antagonism of atracurium with neostigmine

Abstract

Summary In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium‐induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 μg/kg, 35 μg/kg, 55 μg/kg or 75 μg/kg). The recovery times to a train‐of‐four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average TI of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 μg/kg, 55 μg/kg or 75 μg/kg. Recovery after neostigmine 15 μg/kg was significantly slower than after the higher doses. One patient given neostigmine 75 μg/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 μg/kg of neostogmine as a single bolus.

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

“…These doses are comparable to those used in previous studies [14][15][16][17]. Goldhill et al [28] found no increased degree of antagonism at neostigmine doses > 35 lg.kg )1 . Baurain et al [17] compared the effects of neostigmine 20, 40, and 80 lg.kg )1 on neuromuscular blockade induced by vecuronium, and concluded that 40 lg.kg )1 was the most effective dose.…”

“…Goldhill et al . [28] found no increased degree of antagonism at neostigmine doses > 35 μg.kg −1 . Baurain et al .…”

Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function

“…Twenty minutes after neostigmine administration, only 11 of 40 individuals had reached this level of neuromuscular recovery. Perhaps a larger dose of neostigmine (0.07 mg/kg) would have resulted in marginally better antagonism, but the evidence for this is not very convincing [24,25].…”

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…S23 (http://links.lww.com/ALN/C929; very low strength of evidence). 77,145,147,155–157 Time to train-of-four ratio greater than or equal to 0.9 for neostigmine antagonism of cisatracurium and atracurium is shown in table 8. Supplemental tables S19 and S20 (http://links.lww.com/ALN/C928) detail the strength-of-evidence ratings.…”