Neostigmine for reversal of neuromuscular block in paediatric patients

Yang, Lei; Yang, Di; Li, Qian; Zuo, Yunxia; Lü, Donghao

doi:10.1002/14651858.cd010110

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Other contributors to the effect of lower dosage of neostigmine in pediatric patients include the local differences at the neuromuscular junction in children (eg, the number and quantity of nicotinic receptors, amount of acetylcholine reserve, or acetylcholinesterase enzyme activity), a more rapid circulation time and the increased cardiac output speeding the delivery of these agents to the neuromuscular junction and the onset of effect, and more rapid removal of NMBDs from the neuromuscular junction 38,94,95. Up till now, there have not been enough sound evidence for confirming both the efficacy and safety of appropriate use of neostigmine to reverse neuromuscular block in pediatric patients, and further studies with more coherent design and measurements are needed 96…”

Section: Neostigmine For Special Patientsmentioning

confidence: 99%

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Luo¹,

Chen²,

Min³

et al. 2018

TCRM

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Postoperative residual neuromuscular block is a serious threat which endangers the patient safety. Neostigmine has been the most commonly used anticholinesterase for the pharmacological reversal of neuromuscular blockade. Although newer agents have been introduced recently, neostigmine has some irreplaceable advantages, including broad-spectrum reversal of all nondepolarizing neuromuscular blocking drugs, low cost, and availability of more related data for clinical practice to refer to. Neostigmine is also noticed to have some drawbacks, such as the inability to reverse profound and deep blockade, potential induction of muscle weakness, cardiovascular adverse effects, and so on. Data on the usage of neostigmine in the geriatric and the pediatric population are still insufficient. Some discrepancies are observed in the results from previous studies which need further investigation. However, recent studies offer some renewed information. Regarding both efficacy and safety, the key for successful reversal of neuromuscular blockade is to use neostigmine “appropriately,” optimizing the dosage and timing of administration under close monitoring.

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Section: Neostigmine For Special Patientsmentioning

confidence: 99%

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Luo¹,

Chen²,

Min³

et al. 2018

TCRM

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“…These drugs if used alone are associated with certain untoward effects such as increased secretions and mucus resulting in elevated airway resistance, vomiting, diarrhea, and decreased heart rate. [2][3][4] To counter these undesirable effects, anticholinergic agents atropine and glycopyrrolate are often used in conjunction with neostigmine.…”

Section: Introductionmentioning

confidence: 99%

Comparison between the Effects of Combination of Atropine plus Glycopyrrolate with Atropine alone on Heart Rate for the Reversal of Muscle Relaxant after General Anesthesia

Ali¹,

Fareed²,

Mir³

et al. 2022

PJMHS

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Background: A muscle relaxant is an integral component of general anesthesia. Anticholinesterase drugs employed as their antagonist are associated with certain untoward effects. To counter these undesirable effects, anticholinergic agents, atropine, and glycopyrrolate are often used. Objectives: To compare and quantify the mean change in heart rate in patients receiving atropine (0.5 mg) alone, glycopyrrolate (0.5 mg) alone, and atropine (0.25 mg) plus glycopyrrolate (0.25 mg) after muscle relaxant reversal with neostigmine. Study Design: Randomized controlled trial Place and Duration of Study: Department of Anesthesiology and General Surgery Operation Theatre, Nishtar Medical University Multan from 1st January 2021 to 30th June 2021. Methodology: Ninety patients fulfilling inclusion and exclusion criteria undergoing elective cholecystectomy or ventral hernia repair under general anesthesia were included in this study. Group A (n= 30) received Atropine 0.5mg IV, Group G (n=30) received Glycopyrrolate 0.5mg IV while Group A+G (n=30) received atropine 0.25mg plus glycopyrrolate 0.25mg. Data regarding patients’ age, gender, ASA status, type of procedure and operation time, detailed clinical history, and laboratory investigations were taken for all patients. Heart rate of patients before muscle relaxant reversal and after 3 minutes of reversal was noted and heart rate change was calculated. Results: Mean change in heart rate in group A+G was 9.06±3.55 beats/min, 18.53±9.61 beats/min in group A and 17.26±6.20 beats/min in group G. This difference was statistically significant with a p-value <0.0001. Conclusion: Atropine and glycopyrrolate combination is more effective than atropine or glycopyrrolate alone in preventing the heart rate variability associated with reversal of neuromuscular blockers using neostigmine. Keywords: tropine, Glycopyrrolate, Heart rate.

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“…Standard tests such as sustained head lift, hand‐grip strength, and leg lift are not possible in children, and neuromuscular monitoring is not routinely used. Furthermore, the use of neostigmine is associated with postoperative nausea, vomiting, increased salivation, and bradycardia; the dose of neostigmine should be limited to 0.06 to 0.08 mg/kg, as additional doses produce no further reversal of NMB …”

mentioning

confidence: 99%

Beware of the extravasation of muscle relaxant in children

Bhalotra

2018

Pediatric Investigation

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Neostigmine for reversal of neuromuscular block in paediatric patients

Cited by 4 publications

References 14 publications

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Comparison between the Effects of Combination of Atropine plus Glycopyrrolate with Atropine alone on Heart Rate for the Reversal of Muscle Relaxant after General Anesthesia

Beware of the extravasation of muscle relaxant in children

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