Comparison of Neuromuscular Blockade Recovery Co-Administered With Neostigmine and Different Doses of Calcium Gluconate: A Randomized Control Trial

Abstract

Background: Calcium increases the probability of transmitter release at the neuromuscular junction. However, it is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups.Methods: Patients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). The primary endpoint was neuromuscular recovery time. The secondary endpoints were the incidence of PORC at 5, 10, and 20 minutes after reversal administration and the train-of-four ratio (TOFr) at each time point.Results: The neuromuscular recovery time was 5.3 minutes in the control group, 3.9 minutes in the calcium 5 group, and 4.1 minutes in the calcium 10 group, respectively (P=0.012). Neuromuscular recovery time was significantly different between the control and calcium 10 groups (P=0.017). The incidence of PORC at 5 minutes after neostigmine administration was 12 (46.2%) in the control group, 4 (15.4%) in the calcium 5 group, and 4 (15.4%) in the calcium 10 group, respectively, with statistical significance (P=0.014). Conclusions: The co-administration of 10 mg/kg calcium gluconate with neostigmine achieved early NMB recovery and had the fewest variables.Trial Registration: https://cris.nih.go.kr/cris/index.jsp(KCT0004182). Date of registration:12 august 2019.

Effects of different doses of calcium gluconate combined with neostigmine on the recovery of neuromuscular blockade in the elderly

“…We observed a transient hyperdynamic state in the hemodynamics of the four groups of patients when antagonists were given alone or concomitantly with calcium gluconate injection, which stabilized after 10 min, similar to the ndings of So Ron Choi [13] . The clinical onset of action was 2 min for neostigmine and 10-30 s for atropine, and generally atropine and neostigmine should be injected simultaneously in the same syringe to counteract the slowing of heart rate induced by neostigmine, thus showing early manifestations of increased heart rate.…”