Is recovery of neuromuscular transmission complete after the use of neostigmine to antagonize block produced by rocuronium, vecuronium, atracurium and pancuronium?

Abstract

To test if recovery of neuromuscular transmission is complete after the use of neostigmine under standardized conditions, we have measured adductor pollicis mechanical activity in response to 0.1 Hz (twitch height), train-of-four (TOF) and 100 Hz (RF 100 Hz) ulnar nerve stimulations. We studied 56 adult anaesthetized (thiopentone, fentanyl, nitrous oxide in oxygen) patients, allocated randomly to one of four groups (n = 14) to receive rocuronium (group Roc), vecuronium (group Vec), atracurium (group Atr) or pancuronium (group Pan). Recovery of neuromuscular transmission was studied for 15 min after neostigmine 40 micrograms kg-1 was given at 25% recovery of twitch height. Fifteen minutes after antagonism, the TOF ratio was 0.91 (SEM 0.01), 0.88 (0.02) and 0.92 (0.01) (ns), and RF 100 Hz was 0.78 (0.01), 0.79 (0.02) and 0.78 (0.01) (ns) respectively, in patients in groups Roc, Vec and Atr, respectively. In patients in group Pan, TOF ratio and RF 100 Hz were only 0.76 (0.01) and 0.33 (0.04) respectively (P < 0.01, one-way analysis of variance, Duncan's multiple classification range tests). In contrast with pancuronium, antagonism of rocuronium-, vecuronium- and atracurium-induced neuromuscular blocks produced a similar high degree of recovery of neuromuscular transmission.

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

“…Measurements of T1 ⁄ control and train-of-four ratio (TOFR) were taken 3 min, 6 min, 9 min, 12 min and 15 min after the administration of neostigmine, and the values for the two groups were compared. It has been shown that 15 min after the administration of neostigmine at a T1 ⁄ control value of 0.25, TOFR often does not return to 0.9 [14][15][16][17].…”

“…Further, it has been postulated that if neostigmine 40 lg.kg )1 is administered when T1 ⁄ control = 0.25, TOFR returns to a value of 0.9 after about 15 min [14][15][16]. For this reason, recovery from neuromuscular blockade was studied for 15 min after neostigmine administration in this study.…”

“…is given to reverse vecuronium-induced neuromuscular blockade, TOFR may still be increasing > 10 min after neostigmine administration [14][15][16]. Further, it has been postulated that if neostigmine 40 lg.kg )1 is administered when T1 ⁄ control = 0.25, TOFR returns to a value of 0.9 after about 15 min [14][15][16].…”

Reversal of neuromuscular blockade with sugammadex in patients with myasthenia gravis

“…Furthermore, cholinesterase inhibitors are unable to reverse deep neuromuscular blockade due to their mechanism of action. 35,36 In our patients, the pre-NMBA TOF ratio ranged from 0.45 to 1.0 and administration of the NMBA resulted in a maximal depth of neuromuscular blockade ranging from a TOF ratio of 0 to 0.19, or a PTC of 0 to 1. After reversal of neuromuscular blockade with sugammadex, all patients recovered from neuromuscular blockade to their preoperative TOF ratio, indicating that sugammadex reversal was complete and led to a rapid reappearance of normal muscle activity in our patients with myasthenia gravis.…”

Postoperative Residual Curarisation After Vekuronium and Rocuronium

“…Orta etkili kas gevşeticilerin kendi aralarında, kas gevşetici cinsi açısından, postoperatif rezidüel kürarizasyon insidansında fark olmadığını bildiren çalışmalar mevcuttur (16)(17)(18). Bunlardan Hayes ve ark.…”