title: Neostigmine and edrophonium antagonism of varying intensity neuromuscular blockade induced by atracurium, pancuronium, or vecuronium.
abstract: To compare the time course of neostigmine and edrophonium antagonism of varying intensity neuromuscular blockade induced by atracurium, pancuronium, or vecuronium, the authors studied 98 patients anesthetized with nitrous oxide (60%) and halothane or enflurane. Neuromuscular blockade, as monitored by single stimulus-induced twitch tension (TT), was antagonized at varying degrees of spontaneous recovery (2-80% of control TT). Time to antagonism (time from injection of neostigmine or edrophonium to 90% recovery of control TT) was not different between edrophonium, 0.5 mg/kg, and neostigmine, 0.04 mg/kg, when spontaneous recovery had been allowed to occur to at least 11% of control TT prior to antagonist administration (P greater than 0.05). For profound neuromuscular blockade (TT less than or equal to 10% of control) induced by pancuronium or vecuronium, time (mean +/- SD) to antagonism with neostigmine, 0.04 mg/kg, was 7.0 +/- 2.2 min and 5.6 +/- 1.7 min, respectively, while the same for edrophonium, 0.5 mg/kg, was 20.0 +/- 8.0 min and 15.0 +/- 12.5 min, respectively (P less than 0.05). Time to antagonism of profound atracurium-induced neuromuscular blockade was 8.5 +/- 3.3 min for neostigmine, 0.04 mg/kg, and 9.8 +/- 7.0 min for edrophonium, 0.5 mg/kg, (P less than 0.05). For profound vecuronium-and pancuronium-induced neuromuscular blockade, time to antagonism by edrophonium, 1.0 mg/kg, was 4.6 +/- 3.0 min and 3.9 +/- 1.6 min respectively. The authors conclude that neostigmine, 0.04 mg/kg, antagonizes neuromuscular blockade within 12 min when TT is greater than 2% of control at time of reversal. When TT is greater than 10% of control, edrophonium, 0.5 mg/kg, produces similar time to antagonism.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.forename: S M
authors.initials: SM
authors.lastname: Rupp
authors.forename: J W
authors.initials: JW
authors.lastname: McChristian
authors.forename: R D
authors.initials: RD
authors.lastname: Miller
authors.forename: J A
authors.initials: JA
authors.lastname: Taboada
authors.forename: R
authors.initials: R
authors.lastname: Cronnelly
mesh_terms: D000758:Anesthesia; D001279:Atracurium; D004491:Edrophonium / Q000494:pharmacology*; D004737:Enflurane; D006221:Halothane; D006801:Humans; D007546:Isoquinolines / Q000037:antagonists & inhibitors*; D007700:Kinetics; D009388:Neostigmine / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects*; D009609:Nitrous Oxide; D010197:Pancuronium / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors*; D013997:Time Factors; D014673:Vecuronium Bromide
chemical_list: D007546:Isoquinolines; D001279:Atracurium; D009388:Neostigmine; D004491:Edrophonium; D014673:Vecuronium Bromide; D004737:Enflurane; D010197:Pancuronium; D009609:Nitrous Oxide; D006221:Halothane