title: Optimum dose of neostigmine to reverse shallow neuromuscular blockade with rocuronium and cisatracurium.
abstract: We examined the use of neostigmine for reversing shallow (defined as train-of-four ratio of 0.5), cisatracurium- and rocuronium-induced neuromuscular block in 112 patients, by use of 0 μg.kg(-1) , 10 μg.kg(-1) , 20 μg.kg(-1) or 40 μg.kg(-1) dose of neostigmine for reversal. The times from neostigmine administration to train-of-four ratios of 0.7, 0.9 and 1.0 were evaluated. Analysis of variance showed that the duration of action was significantly longer after cisatracurium compared with rocuronium. The time to reach a train-of-four ratio of 1.0 was significantly shorter with neostigmine 40 μg.kg(-1) compared with lower neostigmine doses, and at this dose the time did not differ between cisatracurium and rocuronium. The recovery time from a train-of-four ratio of 0.5-1.0 did not differ between cisatracurium and rocuronium, and was significantly shortened by the administration of neostigmine. We conclude that a neostigmine dose of 40 μg.kg(-1) was the most effective at reducing recovery time after neuromuscular blockade.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, Korea.
authors.forename: E S
authors.initials: ES
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, Korea.
authors.forename: A Y
authors.initials: AY
authors.lastname: Oh
authors.affiliation: Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.
authors.forename: K S
authors.initials: KS
authors.lastname: Seo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Hwang
authors.affiliation: Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Sungnam-si, Korea.
authors.forename: B W
authors.initials: BW
authors.lastname: Koo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: B G
authors.initials: BG
authors.lastname: Kim
mesh_terms: D000704:Analysis of Variance; D000732:Androstanols / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology*; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors; D000077123:Rocuronium; D013997:Time Factors
chemical_list: D000732:Androstanols; D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009388:Neostigmine; C101584:cisatracurium; D000077123:Rocuronium