Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children.
This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1+/-8.8 min and the recovery index (time between T25 and T75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.
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Department of Anesthesiology and Pain Medicine, Seoul National University Children's Hospital, Seoul, Korea.
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Kim
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D000704:Analysis of Variance; D000732:Androstanols / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use*; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D011336:Probability; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*; D020127:Recovery of Function; D018570:Risk Assessment; D000077123:Rocuronium; D000077149:Sevoflurane; D013997:Time Factors
D000732:Androstanols; D018685:Anesthetics, Inhalation; D002800:Cholinesterase Inhibitors; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D011729:Pyridostigmine Bromide; D000077123:Rocuronium