2010
DOI: 10.1097/aln.0b013e3181c53863
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Antagonism of Low Degrees of Atracurium-induced Neuromuscular Blockade: Dose-Effect Relationship for Neostigmine

Abstract: Reduced doses (10-30 microg/kg) of neostigmine are effective in antagonizing shallow atracurium block. For successful reversal within 10 min, as little as 20 microg/kg neostigmine may be sufficient. These dose recommendations are specific for atracurium and an intravenous anesthetic background.

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Cited by 94 publications
(61 citation statements)
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“…[6][7][8][9] Reversal of neuromuscular blockade at the end of surgery is an important strategy for accelerating the recovery from neuromuscular transmission block. 10,11 To date, acetylcholinesterase inhibitors are most frequently used for reversal of NMBA, 10,12 but due to their indirect mode of action their ability to reverse profound residual neuromuscular blockade induced by a high concentration of muscle relaxants is limited 13,14 and they have undesirable muscarinergic side effects. 15,16 Sugammadex 17 reverses any degree of vecuronium-or rocuronium-induced block 18,19 by encapsulating the drug and thereby inactivating it, but the drug has not yet been approved by the Food and Drug Administration because concerns related to allergic reactions and hemorrhagic side effects need to be addressed before resubmission.…”
mentioning
confidence: 99%
“…[6][7][8][9] Reversal of neuromuscular blockade at the end of surgery is an important strategy for accelerating the recovery from neuromuscular transmission block. 10,11 To date, acetylcholinesterase inhibitors are most frequently used for reversal of NMBA, 10,12 but due to their indirect mode of action their ability to reverse profound residual neuromuscular blockade induced by a high concentration of muscle relaxants is limited 13,14 and they have undesirable muscarinergic side effects. 15,16 Sugammadex 17 reverses any degree of vecuronium-or rocuronium-induced block 18,19 by encapsulating the drug and thereby inactivating it, but the drug has not yet been approved by the Food and Drug Administration because concerns related to allergic reactions and hemorrhagic side effects need to be addressed before resubmission.…”
mentioning
confidence: 99%
“…They found that only 16% of patients recovered to a TOF ≥ 0.9 at 10 min after reversal, even when 3 or 4 tactile TOF responses were present at the time of neostigmine administration [17]. Fuchs-Buder et al investigated the reversal of a shallow block corresponding to a TOF ratio of 0.4-0.6 using different doses, and found that a dose of 20 lg.kg À1 neostigmine was sufficient for successful reversal within 10 min [18]. One of the limitations of our current study is that we used the maximal dose of neostigmine at a relatively shallow neuromuscular block, thus the recovery timings we report may be optimistic for many clinical scenarios.…”
Section: Discussionmentioning
confidence: 99%
“…Neostigmine administration has limitations such as muscarinic effect, 1,18 recurarization, 18 ceiling effect, 19 no effect for high dose second reversal administration (0.07 mg/kgBW) 20 and weakness of respiratory muscle.…”
Section: Discussionmentioning
confidence: 99%
“…al which showed that the time required was 10 minutes. 20 Likewise, another study by Kajal et. al showed that the recovery time of the patient was 10 minutes after neostigmine 0.01-0.03 mg/kgBW with a shallow degree of neuromuscular block at the end surgery.…”
Section: 112038mentioning
confidence: 99%