Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium.
OBJECTIVE
To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium- and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA).


METHODS
One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg x kg(-1), mivacurium 0.25 mg x kg(-1), rocuronium 0.9 mg x kg(-1) or cisatracurium 0.15 mg x kg(-1). Patients in each treatment group either received edrophonium (0.5 mg x kg(-1)) at 10% recovery of the first twitch (T1) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated.


RESULTS
The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 +/- 7.8 vs 26.2 +/- 4.9 (mean +/- SD) min], rocuronium (24.7 +/- 14.3 vs 44.4 +/- 13.0 min) and cisatracurium (24.2 +/- 5.7 vs 35.1 +/- 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 +/- 8.0 vs 17.6 +/- 6.1 min).


CONCLUSIONS
Recovery from rapacuronium-, rocuronium- or cisatracurium- induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery.
Suzuki
Takahiro
T
Department of Anesthesiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA. suzukit@cd5.so-net.ne.jp
Lien
Cynthia A
CA
Belmont
Matthew R
MR
Tjan
Joseph
J
Savarese
John J
JJ
D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000037:antagonists & inhibitors; D001279:Atracurium / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D004491:Edrophonium / Q000494:pharmacology*; D004558:Electric Stimulation; D006801:Humans; D007546:Isoquinolines / Q000494:pharmacology; D007821:Laryngeal Muscles / Q000187:drug effects* / Q000294:innervation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D000077590:Mivacurium; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors*; D000077123:Rocuronium; D013997:Time Factors; D016896:Treatment Outcome; D014673:Vecuronium Bromide / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors
D000732:Androstanols; D002800:Cholinesterase Inhibitors; D007546:Isoquinolines; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D004491:Edrophonium; D000077590:Mivacurium; D014673:Vecuronium Bromide; C082938:rapacuronium; C101584:cisatracurium; D000077123:Rocuronium