Dosage of neostigmine for reversal of rocuronium block from two levels of spontaneous recovery

Abstract

SummarySpontaneous recovery, and recovery following neostigmine 20, 35 or 50 mg.kg ¹1 administered at 10 or 25% of recovery of the first twitch of the train-of-four, was assessed in 80 patients after rocuronium administration under continued isoflurane anaesthesia. In an additional 40 patients, isoflurane administration was discontinued and neostigmine 35 or 50 mg.kg ¹1 was given at 10 or 25% recovery. The administration of neostigmine reduced the recovery times significantly. A neostigmine dose of 20 mg.kg ¹1 resulted in slower recovery compared with the higher doses, particularly when reversal was attempted at a first twitch height of 10%. Higher doses of neostigmine given at a first twitch height of 25% resulted in rapid reversal of block [mean (SD) times of 7.0 (4.8) and 6.4 (1.9) min with the 35 and 50 mg.kg ¹1 doses, respectively, for attaining a train-of-four ratio of 0.8]. Discontinuing isoflurane did not alter recovery times. The incidence of emetic symptoms did not differ between groups, including one group that received atropine instead of glycopyrronium in combination with neostigmine. We conclude that rocuronium block can be antagonised safely using a neostigmine dose of 35 mg.kg ¹1 , although recovery may be slightly slower if administered at a first twitch of 10% of control.

Neostigmine injected 5 minutes after low-dose rocuronium accelerates the recovery of neuromuscular function

“…However, neostigmine 0.07 mg/kg is more likely to be associated with side effects than are neostigmine doses of 0.03 mg/kg and 0.05 mg/kg. Viby-Mogensen et al advocated that administration of anticholinesterases not take place before 25% recovery was achieved, because reversal of long-lasting, nondepolarizing muscle relaxants might lead to incomplete recovery of neuromuscular block [9]. However, neuromuscular block from moderate doses of the medium-lasting muscle relaxant rocuronium can rapidly be reversed following neostigmine administration.…”

“…Group 3 (n = 20) was used as the control group, with spontaneous recovery from neuromuscular block. Doses of neostigmine 0.03 mg/kg and 0.05 mg/kg were reported to safely antagonize rocuronium block [9].…”

Residual paralysis: a real problem or did we invent a new disease?

“…For example, McCourt et al found no difference between 35 and 50 lgÁkg -1 in time to full recovery. 24 In another study, the time course of effect for 30, 40, and 55 lgÁkg -1 was very similar. 25 Neostigmine thus provides only partial recovery.…”

Neostigmine antagonism of rocuronium block during anesthesia with sevoflurance, isoflurane or propofol

“…4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia. …”

“…4 Although there are reports of antagonism of rocuronium block with neostigmine, these have generally examined the influence of the dosage or the timing of administration of the anticholinesterase. [5][6][7] The aim of the present study was to examine the effect of the sevoflurane on the antagonism of rocuronium by neostigmine, and compare it with the effects of isoflurane, and intravenous anesthesia. Patients and methods One hundred and twenty three ASA I or II patients (of whom three were replacement patients), aged between 18 and 65 yr, and scheduled to undergo elective body surface or orthopedic surgery lasting longer than 30 min were recruited into the study following their written informed consent and Research Ethics Committee approval.…”