Neostigmine after spontaneous recovery from neuromuscular blockade

Goldhill, D. R.; Wainwright, A. P.; Stuart, C. S.; Flynn, P. J.

doi:10.1111/j.1365-2044.1989.tb11280.x

Cited by 52 publications

(12 citation statements)

References 24 publications

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“…Another study reported similar reintroduction of neuromuscular blockade with a second dose of neostigmine (2.5 mg) after the first dose at 1 hour after administration of vecuronium 51. A later study also indicated that a second dose of neostigmine 2.5 mg diminished tetanic height and increased tetanic fade after the first dose (2.5 mg) administered for reversal of atracurium-induced neuromuscular blockade, which might adversely affect neuromuscular function 24. It was found that some patients (eight in 60) who were given 0.04 mg/kg neostigmine at 2–4 hours after a single dose of vecuronium (0.1 mg/kg) had decreased TOFR after the administration, and the TOFR of those patients had recovered to ≥0.9 at the time of reversal, although this effect was short-lived (only 10–20 minutes) 24,52.…”

Section: Administration For Neuromuscular Blockade Reversalmentioning

confidence: 83%

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Luo¹,

Chen²,

Min³

et al. 2018

TCRM

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Postoperative residual neuromuscular block is a serious threat which endangers the patient safety. Neostigmine has been the most commonly used anticholinesterase for the pharmacological reversal of neuromuscular blockade. Although newer agents have been introduced recently, neostigmine has some irreplaceable advantages, including broad-spectrum reversal of all nondepolarizing neuromuscular blocking drugs, low cost, and availability of more related data for clinical practice to refer to. Neostigmine is also noticed to have some drawbacks, such as the inability to reverse profound and deep blockade, potential induction of muscle weakness, cardiovascular adverse effects, and so on. Data on the usage of neostigmine in the geriatric and the pediatric population are still insufficient. Some discrepancies are observed in the results from previous studies which need further investigation. However, recent studies offer some renewed information. Regarding both efficacy and safety, the key for successful reversal of neuromuscular blockade is to use neostigmine “appropriately,” optimizing the dosage and timing of administration under close monitoring.

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Section: Administration For Neuromuscular Blockade Reversalmentioning

confidence: 83%

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Luo¹,

Chen²,

Min³

et al. 2018

TCRM

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“…The upper limit of anticholinesterase dosage is limited by a "ceiling effect" at high doses and deep levels of block 63 and potential adverse effects on neuromuscular function when high or repeated doses are used. 64 The factors enumerated above influence the degree of neuromuscular blockade at which reversal should be attempted. With respect to safe clinical practice, certain conclusions can be drawn.…”

Section: Incidence and Aetiologymentioning

confidence: 99%

Postoperative Residual Curarisation: Incidence, Aetiology and Associated Morbidity

1993

Anaesth Intensive Care

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HOW SHOULD POSTOPERATIVE RESIDUAL CURARISATION BE DETECTED? If the neuromuscular blocking effects of a nondepolarising muscle relaxant, which has been administered intraoperatively, persist postoperatively to a degree that neuromuscular function is inadequate, then postoperative residual curarisation is said to be present. Of course, this definition depends on the criteria of "adequate" neuromuscular function. Suggested criteria include those based on simple clinical tests and those based on commonly used techniques for monitoring of neuromuscular function. Clinical indicators of adequate neuromuscular function include tr.e abilities to sustain a headlift for five seconds, to sustain a firm hand-grip or tongue protrusion, to keep the eyes open for five seconds, to cough effectively and the absence of double vision. These tests must be interpreted in the light of the well-recognised differential sensitivities of different skeletal muscles to the effects of muscle relaxants. Since the most important neuromuscular functions are pulmonary ventilation, airway protection and maintenance of airway patency, ideally recovery in these muscles should be measured directly. A reasonable and practicable alternative is to assess muscle groups in which recovery is consistently preceded by that in the diaphragm and muscles of the upper airway. Voluntary hand-grip force can be quantified and used as a measure of postoperative residual muscle weakness. I.' This measure is very sensitive and may be substantially decreased, even when a five-second headlift can be sustained. 2 Corresponding to a degree of skeletal muscle weakness at which maximum inspiratory pressure (MIP) and vital capacity (VC) are decreased to 40070 and 50070 of control values, handgrip strength is reduced to 6070 of its control value J and is undetectable when MIP is-20 cm H20." The *EEA.R.c.S.(I), ER.C.A., Senior Anaesthetic Registrar.

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“…Anticholinesterase agents such as neostigmine, posses neuromuscular blocking properties in the absence of previously administered muscle relaxants [8,9]. Neostigmine, in a small number of patients, has been shown to increase tetanic fade hence a considerable degree of spontaneous recovery from a muscle relaxant has occurred.…”

Section: Response To Querymentioning

confidence: 99%

“…This remains as one of the most common but undetected occurrence in early postoperative period [6][7][8]. Also, it has been shown that neuromuscular blockade can persist for up to 4 hours following even a single dose of Vecuronium (0.1mg/kg) [9].…”

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confidence: 99%

Delayed Recovery from Anaesthesia: Missing Information

Srinivasan¹

2016

JCDR

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Neostigmine after spontaneous recovery from neuromuscular blockade

Abstract: SummaryThe effect of neostigmine on neuromuscular function was examined after spontaneous recovery from an atracurium-induced neuromuscular blockade, which reached a train-of-four ratio of either 0.5 or 0.9. Two doses ofneostigmine 2.5 mg were given 5 minutes apart.

Cited by 52 publications

References 24 publications

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Postoperative Residual Curarisation: Incidence, Aetiology and Associated Morbidity

Delayed Recovery from Anaesthesia: Missing Information

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