Spinal neostigmine diminishes, but does not abolish, hypotension from spinal bupivacaine in sheep.
Spinal neostigmine causes analgesia in animals and humans and abolishes hypotension from spinal bupivacaine in rats. Since drug distribution and action can vary with the size of the spinal cord, we tested the effects of the maximum tolerated dose of spinal neostigmine alone and with bupivacaine in conscious sheep. Neostigmine alone increased arterial blood pressure by 10%, with a statistically significant increase beginning 30 min after injection. Compared with spinal bupivacaine alone, addition of neostigmine resulted in hypotension of slower onset (15 vs 5 min), shorter duration (45 vs 105 min), and smaller magnitude (-18% +/- 3% vs -37% +/- 6%). Addition of neostigmine did not affect height of sensory block from spinal bupivacaine. These data agree with preliminary clinical reports that spinal neostigmine diminishes, but does not abolish, hypotension from spinal bupivacaine in humans.
Department of Anesthesia, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
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D000698:Analgesia; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control*; D007278:Injections, Spinal; D009388:Neostigmine / Q000008:administration & dosage / Q000627:therapeutic use*; D009407:Nerve Block; D010277:Parasympathomimetics / Q000008:administration & dosage / Q000627:therapeutic use*; D012677:Sensation / Q000187:drug effects; D012756:Sheep; D013116:Spinal Cord / Q000187:drug effects; D013997:Time Factors
D000779:Anesthetics, Local; D010277:Parasympathomimetics; D009388:Neostigmine; D002045:Bupivacaine