Neostigmine Antagonism of Vecuronium paralysis during Fentanyl, Halothane, Isoflurane, and Enflurane Anesthesia

Dernovoi, Boris; Ágoston, S.; Barvais, Luc; Baurain, Michel; Lefebvre, Romain; D’Hollander, Alain

doi:10.1097/00000542-198705000-00022

Cited by 29 publications

(27 citation statements)

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“…In this study, neostigmine 40 lg.kg )1 and atropine 0.02 mg.kg )1 were given to antagonise neuromuscular blockade. These doses are comparable to those used in previous studies [14][15][16][17]. Goldhill et al [28] found no increased degree of antagonism at neostigmine doses > 35 lg.kg )1 .…”

supporting

confidence: 80%

“…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].…”

mentioning

confidence: 99%

“…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]. The present study shows that TOFR returned to > 0.9 after administration of neostigmine 40 lg.kg )1 in only one patient in the Diabetic group and in six patients in the Control group.…”

mentioning

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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supporting

confidence: 80%

mentioning

confidence: 99%

mentioning

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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“…9,10 The concurrent administration of enflurane has been shown to impair neostigmine antagonism of both pancuronium and vecuronium blocks, 11,12 and stopping administration of enflurane at the time of neostigmine administration decreases the potentiation of atracurium block produced by enflurane. 1 3 The recovery in the groups where the volatile agent administration was discontinued in the present study was fairly rapid and similar to that in the propofol groups.…”

Section: Discussionmentioning

confidence: 99%

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

Reid

Breslin

Mirakhur

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To examine the influence of continuing administration of sevoflurane or isoflurane during reversal of rocuronium induced neuromuscular block with neostigmine.Methods: One hundred and twenty patients, divided into three equal groups, were randomly allocated to maintenance of anesthesia with sevoflurane, isoflurane or propofol. Neuromuscular block was induced with rocuronium and monitored using train-of-four (TOF) stimulation of the ulnar nerve and recording the force of contraction of the adductor pollicis muscle. Neostigmine was administered when the first response in TOF had recovered to 25%. At this time the volatile agent administration was stopped or propofol dosage reduced in half the patients in each group (n = 20 in each group). The times to attain TOF ratio of 0.8, and the number of patients attaining this end point within 15 min were recorded.Results: The times (mean ± SD) to recovery of the TOF ratio to 0.8 were 12.0 ± 5.5 and 6.8 ± 2.3 min in the sevoflurane continued and sevoflurane stopped groups, 9.0 ± 8.3 and 5.5 ± 3.0 min in the isoflurane continued and isoflurane stopped groups, and 5.2 ± 2.8 and 4.7 ±1.5 min in the propofol continued and propofol stopped groups (P < 0.5-01). Only 9 and 15 patients in the sevoflurane and isoflurane continued groups respectively had attained a TOF ratio of 0.8 within 15 min (P < 0.001 for sevoflurane).Conclusions: The continued administration of sevoflurane, and to a smaller extent isoflurane, results in delay in attaining adequate antagonism of rocuronium induced neuromuscular block. REVIOUS studies have shown that antagonism of block with relaxants such as vecuronium is impeded in the presence of potent volatile agents such as sevoflurane and isoflurane. [1][2][3] It has also been shown that sevoflurane anesthesia potentiates the effect of rocuronium compared with isoflurane and propofol anesthesia. 4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia.

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“…Par exemple, on a pu dEmontrer que le renversement du vEcuronium et de I'atracurium est retardE pendant I'anesthEsie ~ I'enflurane. 34 Des Etudes contr61Ees ont montrE un affaiblissement du renversement de la d-tubocurarine et du pancuronium pendant l'acidose respiratoire et I'alcalose mEtabolique. 36'37 Ceci peut avoir EtE la cause de curarisation rEsistante :h la nEostigmine.…”

Section: Mi~dicamenteusesunclassified

Monitoring, new drugs, and reversal of neuromuscular blocking drugs

Bevan

1991

Can J Anaesth

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Neostigmine Antagonism of Vecuronium paralysis during Fentanyl, Halothane, Isoflurane, and Enflurane Anesthesia

Cited by 29 publications

References 0 publications

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

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

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

Monitoring, new drugs, and reversal of neuromuscular blocking drugs

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