Factors predicting atracurium reversal time

Kirkegaard-Nielsen, Hans; Severinsen, Inge Krogh; Pedersen, Hanne; Lindholm, Peter

doi:10.1034/j.1399-6576.1999.430809.x

Cited by 7 publications

(4 citation statements)

References 21 publications

(25 reference statements)

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“…It has been recommended that an anticholinesterase should only be given when T1/control has returned to 0.25 [17, 25–27]. Furthermore, it has been shown that when an anticholinesterase is administered at a T1/control of 0.25, TOFR may only barely return to a value of 0.9 [14–17].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, recovery from neuromuscular blockade was studied for 15 min after neostigmine administration in this study. It has been recommended that an anticholinesterase should only be given when T1 ⁄ control has returned to 0.25 [17,[25][26][27]. Furthermore, it has been shown that when an anticholinesterase is administered at a T1 ⁄ control of 0.25, TOFR may only barely return to a value of 0.9 [14][15][16][17].…”

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confidence: 99%

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Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Saitoh

Hattori²,

Sanbe³

et al. 2004

Anaesthesia

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SummaryReversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 lg.kg )1 and atropine 20 lg.kg )1 were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Saitoh

Hattori²,

Sanbe³

et al. 2004

Anaesthesia

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“…Thus, they concluded that the duration of action of the relaxant in a given individual is a predictor of reversal time in addition to the TOF count at the time of neostigmine administration. [ 16 ] We would like to believe that similar interindividual variability also reflects in the results we got, explaining such differences between the groups.…”

Section: Discussionsupporting

confidence: 64%

Dose-reversal effect relationship of three different doses of neostigmine in obese patients: A randomised clinical trial

et al. 2017

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Background and Aims:Previous studies suggest that administration of vecuronium based on total body weight rather than ideal body weight (IBW) in obesity results in overdosing with prolonged recovery times. We hypothesised that larger doses of neostigmine could result in faster recovery in obese patients administered vecuronium based on total body weight.Methods:Forty-five obese American Society of Anesthesiologists' II patients undergoing elective surgery under general anaesthesia were randomised into 3 groups to receive neostigmine 30, 40 and 50 μg/kg. Following induction, patients were paralysed with vecuronium 0.1 mg/kg based on total body weight. Reversal was achieved with neostigmine based on the patient's group, and time to train-of-four (TOF) ratios of 0.5, 0.7 and 0.9 measured. The primary outcome variable was time to achieve TOF ratio >0.9.Results:Neostigmine 50 μg/kg achieved faster recovery to TOF 0.7 than neostigmine 30 and 40 μg/kg. There was no significant difference in recovery times to TOF 0.7 in patients receiving either 30 or 40 μg/kg of neostigmine. However, neostigmine 40 μg/kg attained TOF ratio 0.9 faster than 30 μg/kg. We did not note a significant difference between the 40 and 50 μg/kg dose with regard to recovery of TOF to 0.9.Conclusion:Facilitated recovery from neuromuscular blockade to TOF of 0.7 was faster with neostigmine 50 μg/kg compared to 40 or 30 μg/kg. Recovery to TOF ratio of 0.9 was not significantly different with 40 or 50 μg/kg doses although such time was faster as compared to 30 μg/kg dose.

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“…This relationship appears most important when reversing profound levels of NMB. 52 The relationship between the timing of the last dose of the neuromuscular blocking agent, the timing of anticholinesterase administration, and efficacy of antagonism has also been found when pyridostigmine is used to antagonize rocuronium-or vecuronium-induced NMB 53 and when neostigmine (2.5 mg) is used to antagonize pancuronium-induced block. 54 Spontaneous recovery of neuromuscular function is one of the factors contributing to return of baseline muscle strength at the conclusion of an anaesthetic during which a neuromuscular blocking agent was administered.…”

Section: Pharmacological Antagonism Of Residual Nmbmentioning

confidence: 98%

Development and potential clinical impact of ultra-short acting neuromuscular blocking agents

Lien

2011

British Journal of Anaesthesia

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Developing a non-depolarizing neuromuscular blocking agent that, like succinylcholine, has a rapid onset and a short duration of effect remains a goal of ongoing research. While rocuronium fills a portion of this need, the large doses required for rapid intubation render it a much longer-acting neuromuscular blocking agent. Postoperative residual neuromuscular block (NMB) is an increasingly recognized complication of non-depolarizing neuromuscular blocking agents. This occurs because of dosing choices for neuromuscular blocking agents and anticholinesterases as well as insensitivity of typically used monitors of depth of NMB. While antagonism of NMB is necessary with partial recovery, it is unnecessary with more complete recovery. Even when monitoring with an accelerograph, reversal of NMB is complicated. In addition to the pharmacodynamics of the individual neuromuscular blocking agents, factors such as timing of anticholinesterase administration, dose of anticholinesterase, concomitant medications, electrolyte abnormalities, and hepatic or renal disease can influence the degree of reversal. Sugammadex works differently than anticholinesterases and, when administered in appropriate doses, can reverse even profound block induced with vecuronium or rocuronium. Two new fumarate neuromuscular blocking agents have a rapid onset of effect and can be reversed at any time by administration of cysteine, which could significantly reduce the risk of postoperative residual NMB.

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Factors predicting atracurium reversal time

Cited by 7 publications

References 21 publications

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Dose-reversal effect relationship of three different doses of neostigmine in obese patients: A randomised clinical trial

Development and potential clinical impact of ultra-short acting neuromuscular blocking agents

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