Comparison of neostigmine-induced recovery with spontaneous recovery from mivacurium-induced neuromuscular block

Abstract

In 24 ASA I-II adults anaesthetized with thiopentone, fentanyl and nitrous oxide in oxygen, we studied neuromuscular transmission with isometric adductor pollicis monitoring. Patients received mivacurium 0.2 mg kg-1 followed by an infusion lasting at least 60 min and adjusted to maintain twitch height at 1-5%. After termination of the mivacurium infusion, when twitch height spontaneously regained 25% of its control value, the patients were allocated to two groups of 12 patients each. In group NEO patients received neostigmine 40 micrograms kg-1 and atropine 15 micrograms kg-1 and in group SPO neuromuscular transmission was allowed to recover spontaneously. Twitch height was measured every 10 s and train-of-four (TOF) (2 Hz) every 3 min. After 15 min, residual force after tetanic stimulation (50 and 100 Hz, 5-s duration (RF50HZ, RF100HZ), 1 min apart) were recorded sequentially. At 15 min, mean TOF ratio was greater in group NEO (0.94 (SEM 0.01)) than in group SPO (0.87 (0.02)) (P < 0.01). All patients in group NEO recovered to a TOF ratio greater than 0.7 after 6 min compared with 15 min in group SPO (P < 0.005). A TOF ratio greater than 0.9 was observed in all patients in group NEO compared with only six in group SPO (P < 0.025). Nevertheless, RF50HZ and RF100HZ did not differ significantly (0.92 (0.01) (group NEO), 0.91 (0.01) (group SPO) and 0.83 (0.02) (group NEO), 0.78 (0.03) (group SPO), respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Is recovery of neuromuscular transmission complete after the use of neostigmine to antagonize block produced by rocuronium, vecuronium, atracurium and pancuronium?

“…In patients receiving short-acting neuromuscular blockers such as mivacurium, neostigmine, given under the same clinical conditions, also accelerated recovery of the TOF ratio to 0.9. However, unlike the patients in this study who received medium-acting neuromuscular blockers, all patients obtained a TOF ratio of 0.9 within 15 min of administration of neostigmine, compared with 50% of patients during spontaneous recovery of mivacurium-induced block 26 . The use of short-acting neuromuscular blockers such as mivacurium should probably make Figure 2 Values for residual force (RF) after 100 Hz tetanic stimulation (RF 100 Hz) recorded 15 min after administration of neostigmine 40 g kg 91 when twitch height had regained 25% of its initial value (mean, SEM).…”

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Neostigmin und Edrophonium

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Antagonisierung einer tiefen und oberflächlichen Mivacuriumblockade raten Mivacuriumblock durch Edrophonium oder Neostigmin signifikant beschleunigt wird [3,19,23,24]. Zusätzlich wurde in jüngsten Arbeiten gezeigt, daß ein tiefer Mivacuriumblock durch Edrophonium effektiver antagonisierbar ist als durch Neostigmin [1,11].

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