title: Edrophonium is better than neostigmine to antagonize residual vecuronium induced neuromuscular block.
abstract: Edrophonium (EDR) has the advantages of a quick onset of action and reduced cholinergic effects compared to neostigmine (NST) when they are used to antagonize neuromuscular block (NMB). There are few studies about antagonism of very weak residual NMB. Therefore we compared hemodynamic stability, train-of-four (TOF) characteristics and reversal time (time from administration of antagonists to train-of-four-ratio (TR) at least 0.70) of EDR 0.5 mg kg-1 + atropine (ATR) 0.007 mg kg-1 to NST 0.04 mg kg-1 + glycopyrrolate (GLY) 0.008 mg kg-1 when they were used to antagonize a residual vecuronium (VEC)-induced NMB (T1 25-75%). The NMB was monitored in 64 patients using the evoked electromyogram of the hypothenar muscle of the hand. An adequate antagonism was defined as a TR of 0.70 or higher. Heart rate was significantly higher in NST+GLY group 2 min after administration of the antagonists in comparison with the EDR+ATR group. The advantages of EDR (higher T1, TR and percentage of patients with an adequate recovery) were obvious during the first 5 min of reversal time. Therefore we conclude, that under the conditions described in the present study, EDR antagonizes residual VEC induced NMB faster than NST.
authors.affiliation: Department of Anaesthesiology, Tampere University Hospital, Finland.
authors.forename: A I
authors.initials: AI
authors.lastname: Puura
authors.forename: G A
authors.initials: GA
authors.lastname: Baer
authors.forename: M G
authors.initials: MG
authors.lastname: Rorarius
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D001285:Atropine / Q000008:administration & dosage / Q000494:pharmacology; D004491:Edrophonium / Q000008:administration & dosage / Q000494:pharmacology*; D004576:Electromyography; D006024:Glycopyrrolate / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage / Q000494:pharmacology*; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors*
chemical_list: D009388:Neostigmine; D004491:Edrophonium; D001285:Atropine; D014673:Vecuronium Bromide; D006024:Glycopyrrolate