Time to peak effect of neostigmine at antagonism of atracurium- or vecuronium-induced neuromuscular block
| Autor: | Karsten Bülow, Inge Krogh Severinsen, Hans Kirkegaard-Nielsen, H. S. Helbo‐Hansen, Peter Lindholm |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Time Factors medicine.medical_treatment Neuromuscular transmission Fentanyl medicine Humans Anesthesia Prospective Studies Muscle Skeletal Cholinesterase Vecuronium Bromide Dose-Response Relationship Drug biology business.industry Nerve Block Genitalia Female Middle Aged Electric Stimulation Neostigmine Neuromuscular Nondepolarizing Agents Anesthesiology and Pain Medicine Atracurium biology.protein Nerve block Female Cholinesterase Inhibitors Halothane Vecuronium bromide business medicine.drug |
| Zdroj: | Journal of Clinical Anesthesia. 7:635-639 |
| ISSN: | 0952-8180 |
| Popis: | (1) To determine the time to peak effect of neostigmine (time to peak antagonism) during atracurium- or vecuronium-induced neuromuscular block; and (2) to determine the effect on time to peak effect of neostigmine during atracurium-induced neuromuscular block, when the dose of neostigmine is increased from 35 micrograms/kg to 70 micrograms/kg.Prospective, randomized clinical study.Gynecologic operating room suite at a university hospital.45 ASA I and II women admitted for gynecologic laparotomy.Anesthesia was performed with thiopental sodium, fentanyl, halothane, nitrous oxide, and atracurium or vecuronium. Train-of-four (TOF) stimulation and mechanomyography were used to monitor neuromuscular transmission. Neostigmine was administered while a constant degree of neuromuscular block was maintained at a twitch height at a point between 4% and 11% of the control twitch height, using a continuous infusion of atracurium or vecuronium. The patients were randomized to three groups, with 15 patients in each group. Group 1 received atracurium block antagonized with neostigmine 35 micrograms/kg; group 2 received vecuronium block antagonized with neostigmine 35 micrograms/kg; and group 3 received atracurium block antagonized with neostigmine 70 micrograms/kg.The degree of neuromuscular block at antagonism was similar in the three groups. Time to peak effect (mean +/- SD) on TOF ratio was significantly longer in Group 1 (9.7 +/- 3.0 minutes) versus Group 2 (6.6 +/- 1.4 minutes; (p0.05). The time to peak effect on TOF ratio during atracurium-induced block was reduced from 9.7 +/- 3.0 minutes to 6.3 +/- 2.0 minutes when the dose of neostigmine was increased from 35 micrograms/kg to 70 micrograms/kg (p0.05). The peak effect on TOF ratio was significantly greater in Group 3 compared with Group 1 (p0.05), while it was similar in groups 1 and 2.The time to peak effect of neostigmine 35 micrograms/kg is about 6 to 10 minutes when antagonizing a constant degree of atracurium- or vecuronium-induced neuromuscular block at a twitch height at a point between 4% and 11%. Even though the time to peak effect was longer with atracurium than with vecuronium, clinically significant differences between the antagonizing effect of atracurium versus vecuronium block were not demonstrated. The time to peak effect during atracurium-induced block decreased when the dose of neostigmine was increased from 35 micrograms/kg to 70 micrograms/kg. |
| Databáze: | OpenAIRE |
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