title: The effect of oral pyridostigmine bromide nerve agent prophylaxis on return of twitch height in persons receiving succinylcholine.
abstract: Prophylactic pyridostigmine is used for troops under threat of organophosphate exposure and can affect the neuromuscular blocking agent succinylcholine. The purpose of this study was to determine what effect pyridostigmine would have on neuromuscular blockade from succinylcholine. Thirty-nine subjects were enrolled in this double-blind, placebo-controlled investigation and assigned to either the pyridostigmine or the placebo group. All subjects were evaluated for pyridostigmine or placebo side effects and given an anesthesia induction that included the neuromuscular blocking agent succinylcholine. Neuromuscular blockade was measured by twitch height with a nerve stimulator. Interval data were analyzed using the chi 2 test and Student's t test. The pyridostigmine group demonstrated a prolonged recovery time to return of 25% (p = 0.003) and 75% (p = 0.028) of twitch height compared with the placebo group. No differences were noted for any other parameter measured. We conclude that the recovery from neuromuscular blockade after succinylcholine is prolonged while the intubating conditions remain unaffected.
authors.affiliation: Department of Anesthesia, Naval Medical Center Portsmouth, VA, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Pellegrini
authors.forename: A B
authors.initials: AB
authors.lastname: Baker
authors.forename: D J
authors.initials: DJ
authors.lastname: Fontenot
authors.forename: A F
authors.initials: AF
authors.lastname: Cardenas
mesh_terms: D000284:Administration, Oral; D000769:Anesthesia, Inhalation; D002619:Chemical Warfare Agents / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D004311:Double-Blind Method; D016903:Drug Monitoring; D004357:Drug Synergism; D004576:Electromyography; D006801:Humans; D007442:Intubation, Intratracheal; D008889:Military Personnel; D009431:Neural Conduction / Q000187:drug effects*; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use*; D062025:Organophosphate Poisoning; D011041:Poisoning / Q000517:prevention & control; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000009:adverse effects*; D013390:Succinylcholine / Q000627:therapeutic use*; D013997:Time Factors; D014481:United States
chemical_list: D002619:Chemical Warfare Agents; D002800:Cholinesterase Inhibitors; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D011729:Pyridostigmine Bromide