Effects of neostigmine and pyridostigmine on serum cholinesterase activity

Mirakhur, R. K.; Lavery, T. D.; Briggs, L.P.; Clarke, R.S.J.

doi:10.1007/bf03007949

Cited by 36 publications

(4 citation statements)

References 14 publications

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“…The use of NMBs needs to be considered carefully whether the block has been reversed with anticholinesterases or with sugammadex. Anticholinesterase agents such as neostigmine produce a profound inhibition of plasma cholinesterase activity [54]. This would invariably lead to prolongation of the effects of suxamethonium.…”

Section: Re‐establishment Of Block After Reversal With Sugammadexmentioning

confidence: 99%

Sugammadex in clinical practice

Mirakhur

2009

Anaesthesia

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102

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SummaryThe availability of sugammadex allows greater flexibility in the use of rocuronium and vecuronium during anaesthesia and surgery. The neuromuscular block induced by both drugs can be reversed from both superficial and deep levels of block by adjusting the dose of sugammadex. The dose of sugammadex for reversal of shallow block produced by these neuromuscular blocking drugs is approximately 2 mg.kg )1 and for deep block the dose is 4 mg.kg ) administered 3 min after the neuromuscular blocking drug allows rapid reversal of a neuromuscular block induced by 1-1.2 mg.kg )1 of rocuronium, thereby raising the possibility of using rocuronium as a replacement for suxamethonium. The use of sugammadex has not been reported to be associated with recurrence of block provided a dose that is adequate for reversal has been used. Sugammadex appears to have an acceptable safety profile. There are no requirements for dose adjustment for age or the use of potent volatile anaesthetic agents.

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Section: Re‐establishment Of Block After Reversal With Sugammadexmentioning

confidence: 99%

Sugammadex in clinical practice

Mirakhur

2009

Anaesthesia

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102

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“…The less frequent use of neostigmine compared to pyridostigmine seems to be attributable to a past trend. Compared to pyridostigmine, neostigmine has a faster onset but shorter duration, has a five-fold higher potency, and greater muscarinic action, although there are no differences in recovery with neuromuscular blockade [ 12 , 13 ]. Hence, if an anticholinesterase must be used, neostigmine, which is high potency and has a fast onset of action, is preferentially recommended [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Current use of neuromuscular blocking agents and antagonists in Korea: a 2018 survey

et al. 2019

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Background Neuromuscular blocking agents (NMBAs) and neuromuscular monitoring in anesthetic management are integral for endotracheal intubation, better visualization of the surgical field, and prevention of residual neuromuscular blockade and pulmonary complications. Sugammadex is a drug that reduces risk of residual neuromuscular blockade, with more rapid recovery compared to anticholinesterase. The purpose of this study was to investigate current usage status of NMBAs and antagonist with neuromuscular monitoring, among anesthesiologists in Korea. Methods Anesthesiologists working in Korea were invited to participate in an online survey via email January 2–February 28, 2018. The questionnaire consisted of 45 items, including preferred NMBAs, antagonists, neuromuscular monitoring, and complications related to the use sugammadex. A total of 174 responses were analyzed. Results Rocuronium was a commonly used NMBA for endotracheal intubation (98%) of hospitals, and maintenance of anesthesia (83.3%) in of hospitals. Sugammadex, pyridostigmine, and neostigmine were used in 89.1%, 87.9%, and 45.4% of hospitals. Neuromuscular monitoring was employed in 79.3% of hospitals; however only 39.7% of hospitals used neuromuscular monitoring before antagonist administration. Usual dosage range of sugammadex was 2.1–4 mg/kg in 35.1% of hospitals, within 2 mg/kg in 34.5% of hospitals, and 1 vial regardless of body weight in 22.4% of hospitals. Sugammadexrelated complications were encountered by 14.9% of respondents. Conclusions This survey indicates several minor problems associated with the use of antagonists and neuromuscular monitoring. However, most anesthesiologists appear to have appropriate information regarding the usage of NMBAs and sugammadex.

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“…Mirakhur studied plasma cholinesterase activity in 15 patients in whom neuromuscular block produced by atracurium was antagonized by edrophonium 0.5 or 1.0 mg kg" 1 [3]. In contrast with a previous study [5] in which either pyridostigmine 0.25 mg kg" 1 or neostigmine 0.05 mg kg" 1 was used to antagonize the effects of pancuronium, no change in enzyme activity was observed. It was suggested, therefore, that edrophonium should not prolong the effects of suxamethonium.…”

Section: Commentmentioning

confidence: 99%

Effects of cholinesterase inhibitors on the neuromuscular blocking action of suxamethonium †

Valdrighi

Fleming

Smith

et al. 1994

British Journal of Anaesthesia

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Prolonged neuromuscular block occurs when suxamethonium is given after neostigmine or pyridostigmine; however, studies of edrophonium and suxamethonium have yielded conflicting results. We have studied, therefore, interactions between suxamethonium and all three anticholinesterases in rats anaesthetized with pentobarbitone. After recovery from an initial bolus of suxamethonium, saline, edrophonium, pyridostigmine or neostigmine was administered and a second dose of suxamethonium was then given. All three anticholinesterases prolonged the duration of neuromuscular block (90% suppression to 50% twitch recovery) to 127 (SEM 9)%, 127(10)% and 138 (11)% of baseline for edrophonium, pyridostigmine and neostigmine, respectively. Recovery index (25% to 75% twitch recovery) was increased also to 125 (9)%; 149 (10%) and 185 (15)% of baseline, respectively for the three drugs.

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Effects of neostigmine and pyridostigmine on serum cholinesterase activity

Cited by 36 publications

References 14 publications

Sugammadex in clinical practice

Sugammadex in clinical practice

Current use of neuromuscular blocking agents and antagonists in Korea: a 2018 survey

Effects of cholinesterase inhibitors on the neuromuscular blocking action of suxamethonium †

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