title: Edrophonium antagonism of cisatracurium-induced neuromuscular block: dose requirements in children and adults.
abstract: This randomized, controlled study compared edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N2O anaesthesia, were studied. Cisatracurium 0.1 mg x kg(-1) was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg x kg(-1) or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n=12). Atropine 5 to 10 microg x kg(-1) was given according to edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P<0.01. The times to 10% spontaneous recovery of the first twitch (T1) were respectively, 28.4 (5.2) and 41.8 (6.1) minutes in children and adults, P<0.01. Spontaneous and antagonist assisted neuromuscular recovery was more rapid in children. Adequate neuromuscular recovery (train of four (TOF) ratio 80%) was achieved in children at 3 and 10 minutes after edrophonium 1.0 mg kg(-1) and 0.4 mg x kg(-1), respectively. A TOF ratio of 80% was not achieved, within 10 minutes, with any of the four dose levels of edrophonium in adults. The dose of edrophonium to achieve a TOF ratio of 80% (ED(TOF-80)) after 5 and 10 minutes in children were, respectively, mean (SD) 0.85 (0.38) and 0.38 (0.19) mg x kg(-1). The equivalent ED(TOF-80) in adults was outside the edrophonium dose range studied.
authors.affiliation: Anaesthesiology Department, Faculty of Medicine, Cairo University, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Abdulatif
authors.forename: M
authors.initials: M
authors.lastname: El-Sanabary
mesh_terms: D000328:Adult; D001279:Atracurium / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors*; D002648:Child; D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004491:Edrophonium / Q000008:administration & dosage*; D004558:Electric Stimulation; D006801:Humans; D008875:Middle Aged; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors*; D014459:Ulnar Nerve / Q000502:physiology
chemical_list: D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D004491:Edrophonium; C101584:cisatracurium