Electrical and Mechanical Responses After Neuromuscular Blockade With Vecuronium, and Subsequent Antagonism With Neostigmine or Edrophonium

Astley, B.A.; Katz, Ronald L.; Payne, J. P.

doi:10.1093/bja/59.8.983

Cited by 18 publications

(7 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding of depolarising blockade supports the work of previous authors . Caldwell administered 40 μg.kg −1 of neostigmine to anaesthetised patients who had already recovered to a TOF > 0.9.…”

Section: Discussionsupporting

confidence: 92%

Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind, placebo‐controlled, randomised volunteer study

et al. 2018

View full text Add to dashboard Cite

Neostigmine reverses non-depolarising neuromuscular blockade, but may cause muscle weakness when administered after full recovery of neuromuscular function. We hypothesised that neostigmine in therapeutic doses impairs muscle strength and respiratory function in awake healthy volunteers. Twenty-one volunteers were randomised to receive two doses of either intravenous (i.v.) neostigmine 2.5 mg with glycopyrrolate 450 μg (neostigmine group, n = 14) or normal saline 0.9% (placebo group, n = 7). The first dose was administered immediately after obtaining baseline measurements, and the second dose was administered 15 min later. All 14 volunteers in the neostigmine group received the first dose, mean (SD) 35 (5.8) μg.kg , but only nine of these volunteers agreed to receive the second dose, 34 (3.5) ?g.kg . The primary outcome was hand grip strength. Secondary outcomes were train-of-four ratio, single twitch height, forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity ratio, oxygen saturation, heart rate and mean arterial pressure. The first dose of intravenous neostigmine with glycopyrrolate resulted in reduced grip strength compared with placebo, -20 (20) % vs. +4.3 (9.9) %, p = 0.0016; depolarising neuromuscular blockade with decreased single twitch height, -14 (11) % vs. -3.8 (5.6) %, p = 0.0077; a restrictive spirometry pattern with decreased predicted forced expiratory volume in 1 s, -15 (12) % vs. -0.47 (3.4) %, p = 0.0011; and predicted forced vital capacity, -20 (12) % vs. -0.59 (3.2) %, p < 0.0001 at 5 min after administration. The second dose of neostigmine with glycopyrrolate further decreased grip strength mean (SD) -41 (23) % vs. +1.0 (15) %, p = 0.0004; single twitch height -25 (15) % vs. -2.5 (6.6) %, p = 0.0030; predicted forced expiratory volume in 1 s -23 (24) % vs. -0.7 (4.4) %, p = 0.0063; and predicted forced vital capacity, -27.1 (22.0) % vs. -0.66 (3.9) %, p = 0.0010. Train-of-four ratio remained unchanged (p = 0.22). In healthy volunteers, therapeutic doses of neostigmine induced significant and dose-dependent muscle weakness, demonstrated by a decrease in maximum voluntary hand grip strength and a restrictive spirometry pattern secondary to depolarising neuromuscular blockade.

show abstract

Section: Discussionsupporting

confidence: 92%

Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind, placebo‐controlled, randomised volunteer study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The purpose of this study was to characterize recovery of neuromuscular transmission 15 min after administration of edrophonium with different stimulation patterns, including low stimulation rates (twitch height (TH) 0.1 Hz train-of-four (TOF) 2 Hz) but also tetanic stimulations at 50 and 100 Hz. The use of high stimulation rates is desirable because of the limitations of low frequency stimulation rates for the detection of residual neuromuscular block in several clinical situations [16][17][18][19][20][21][22]. The second purpose was to study the effects of different doses of edrophonium given at various pre-reversal twitch heights on recovery of neuromuscular transmission.…”

mentioning

confidence: 99%

Low and high frequency stimulation tests to characterize the effects of edrophonium on vecuronium-induced neuromuscular block

Baurain

Dernovoi

D’Hollander

et al. 1995

British Journal of Anaesthesia

View full text Add to dashboard Cite

We recorded adductor pollicis mechanical activity in response to low (0.1 and 2 Hz) and high (50 and 100 Hz) frequency stimulation 15 min after edrophonium 250, 500 and 1000 micrograms kg-1, given to antagonize vecuronium-induced block at 10, 25 and 50% pre-reversal twitch height. We studied 54 ASA class I and II anaesthetized (methohexitone, fentanyl, nitrous oxide) young adult patients allocated randomly to nine groups of six patients each. The greater sensitivity of train-of four (TOF) ratio and residual force after 100-Hz, 5-s tetanic stimulation (RF100) to residual deficit allowed discrimination more readily between the effects of edrophonium dose and pre-reversal twitch height (P < 0.001, two-way analysis of variance). The highest reversal scores (approximately 0.9 TOF ratio and 0.6 RF100) were obtained when edrophonium 500-1000 mg kg-1 was given at 50% twitch height (P < 0.05, Duncan's test).

show abstract

“…The short spontaneous recovery time of mivacurium and the altered decrease in plasma concentration, when cholinesterase inhibitors are given, elicit uncertainty whether the use of cholinesterase inhibitors facilitate the reversing process or not. As cholinesterase inhibitors have adverse effects including cardiovascular effects, the potential beneficial effect of reversal should be of significance to justify the use.…”

Section: Introductionmentioning

confidence: 99%

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

Brinch

Söderström

Gätke

et al. 2018

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Mivacurium is a short-acting non-depolarizing muscle relaxant, which is hydrolyzed by butyrylcholinesterase. The neuromuscular block (NMB) can be antagonized with cholinesterase inhibitors (CHEI), but the short duration of action of mivacurium questions the need. This systematic review evaluated if the use of CHEIs (neostigmine, pyridostigmine or edrophonium) facilitates reversal of mivacurium-induced NMB. Method:Randomized controlled trials and crossover-studies comparing spontaneous recovery with CHEI reversal in patients with mivacurium-induced NMB, assessed with quantitative neuromuscular monitoring, were included. Mean time from injection of the CHEI or allowing of spontaneous recovery to an endpoint representing full recovery was used as outcome. First response to train-of-four nerve stimulation (T 1 ) described the level of NMB for administration of the CHEI. Moderate NMB refers to T 1 ≥ 5% and deeper NMB refers to T 1 < 5%. Systematic critical appraisal was performed using the Scottish Intercollegiate Guidelines Network guidelines.Overall quality assessment was done using the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Sixteen studies with data from 546 patients were included. Low quality of evidence was found that neostigmine and edrophonium administered at moderate NMB accelerated recovery with up to approximately 5.5-6.5 and 6.5-9.0 minutes, respectively. At deeper NMB only edrophonium accelerated recovery. The effect of neostigmine was not clarified at deeper mivacurium-induced NMB. No studies with reversal by pyridostigmine were identified.Conclusion: Low quality of evidence supports that neostigmine and edrophonium accelerate the recovery of mivacurium-induced NMB with 5-6.5 and 6-9.0 minutes respectively, when administered at moderate NMB. At deeper NMB only edrophonium accelerated the recovery.

show abstract

Electrical and Mechanical Responses After Neuromuscular Blockade With Vecuronium, and Subsequent Antagonism With Neostigmine or Edrophonium

Cited by 18 publications

References 14 publications

Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind, placebo‐controlled, randomised volunteer study

Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind, placebo‐controlled, randomised volunteer study

Low and high frequency stimulation tests to characterize the effects of edrophonium on vecuronium-induced neuromuscular block

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

Contact Info

Product

Resources

About