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

Abstract

P Pu ur rp po os se e: : To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium-and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA). M Me et th ho od ds s: :One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg·kg ) at 10% recovery of the first twitch (T1) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated.R Re es su ul lt ts s: : The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 ± 7.8 vs 26.2 ± 4.9 (mean ± SD) min], rocuronium (24.7 ± 14.3 vs 44.4 ± 13.0 min) and cisatracurium (24.2 ± 5.7 vs 35.1 ± 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 ± 8.0 vs 17.6 ± 6.1 min).C Co on nc cl lu us si io on n: : Recovery from rapacuronium-, rocuronium-or cisatracurium-induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery. [19,2 ± 7,8 vs 26,2 ± 4,9 (moyenne ± écart type) min], le rocuronium (24,7 ± 14,3 vs 44,4 ± 13,0 min) et le cisatracurium (24,2 ± 5,7 vs 35,1 ± 7,6 min). L'administration d'édrophonium n'a pas raccourci le temps de récupération complète d'un bloc induit par le mivacurium (15,7 ± 8,0 vs 17,6 ± 6,1 min Objectif

Reversal of mivacurium‐induced neuromuscular blockade with a cholinesterase inhibitor: A systematic review

“…Two studies used the predefined endpoint TOF 0.9 . Both studies also presented time to TOF 0.7, which was the endpoint in all other studies, apart from two trials where TOF 0.75 was used as endpoint …”

“…Sixteen randomized controlled studies with data from 546 patients were included . Six studies compared spontaneous recovery with both neostigmine and edrophonium reversal .…”

“…Six studies compared spontaneous recovery with both neostigmine and edrophonium reversal . Five studies compared spontaneous recovery with neostigmine reversal and five studies compared spontaneous recovery with edrophonium reversal No studies on pyridostigmine were included. The overall assessment of the risk of bias for individual studies resulted in three studies judged as high quality, 11 as acceptable and two as low (Table ).…”

“…The NMB induced by long‐acting and intermediate‐acting NDMR can be antagonized with cholinesterase inhibitors such as neostigmine, pyridostigmine or edrophonium. Antagonism performed at the correct depth of NMB accelerates the muscle recovery, thereby decreasing the incidence of residual block and shortening the time to full recovery. Mivacurium is a short‐acting NDMR which is hydrolyzed quickly by butyrylcholinesterase (BChE, plasma cholinesterase).…”

Practice Guidelines for Postanesthetic Care

“…One new RCT corroborates findings reported in the original Guidelines regarding the efficacy of edrophonium to antagonize the effects of neuromuscular blocking agents (e.g., rocuronium, cisatracurium, rapacuronium) when compared with spontaneous recovery (Category A3-B evidence). 71 The original Guidelines indicated that neostigmine is effective for the antagonism of residual neuromuscular blockade (Category A1-B evidence); new literature is insufficient to further evaluate these findings. The original Guidelines reported an increased frequency of postoperative emetic episodes with the use of neostigmine (Category A1-H evidence); new literature is insufficient to further evaluate this finding.…”