Antagonism of Vercuronium-Induced Neuromuscular Blockade With Edrophonium or Neostigmine

Abstract

Antagonism of vecuronium-induced neuromuscular blockade was attempted, at varying degrees of spontaneous recovery, with edrophonium 0.5 mg kg-1 or neostigmine 0.05 mg kg-1 in two groups of 20 patients. Neuromuscular blockade was monitored using a train-of-four (TOF) stimulation. Adequate antagonism of neuromuscular blockade, defined as a sustained TOF ratio of 0.7 or more, was attained in all 20 patients given neostigmine and in 13 out of 20 given edrophonium. Five of the remaining seven patients given edrophonium had shown three or less responses to TOF stimulation before antagonism. While the time to onset of the action of edrophonium (22 s) was not significantly shorter than neostigmine (26 s), the time taken to attain a TOF ratio of 0.7 was significantly shorter with edrophonium (67 s compared with 194 s with neostigmine). It is concluded that edrophonium 0.5 mg kg-1 does not consistently antagonize vecuronium-induced neuromuscular blockade, particularly if there are three or less responses to a TOF stimulation present before antagonism.

Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium

“…Although this dose is sufficient to antagonize lesser degrees of block (i.e., T1 > 25% at the AP), 5,7,23,24 it has been reported that at least 1.0 to 1.5 mg·kg -1 is needed for rapid restoration from vecuronium-or pancuronium-induced block when T1 < 10% of control. 5 The degree of spontaneous recovery prior to antagonism seems to be particularly important when edrophonium, rather than neostigmine, is used.…”

Observations of the potency and duration of vecuronium in isoflurane-anesthetized horses

“…In the present study two horses required several increments of edrophonium before neuromuscular transmission approached normal even though neuromuscular blockade was partial at the time that the cholinesterase inhibitor was given. Difficult reversal of VEC has been reported previously in humans – in those instances neostigmine has been reported to be more effective than edrophonium (Mirakhur et al. 1987).…”

Anticholinergic drugs and anaesthesia

“…Cependant le dEsavantage majeur de I'Edrophonium est l'inconsistance de son action. [24][25][26][27] En concLusion, les agents anticholinergiques exereent des effets significatifs sur la fr~quence cardiaque pouvant ~tre exagErEs lots de I'anesthEsie gEn~rale. Leur utilisation de routine en prEmEdication n'est pus n~cessaire, lls doivent cependant &re utilisEs avec les anticholinestErasiques lots de I'antagonisme des blocs musculaires non d~polarisants.…”