Abstract
Edrophonium administered in divided doses has been reported to accelerate antagonism of neuromuscular blockade, i.e., a «priming” effect. Since measured onset times can be affected by the type of stimulation used, this effect was studied using both train-of-four (TOF) and single twitch (ST) stimulation. During thiopentone-nitrous oxide-enflurane anaesthesia 20 adults were given atracurium 0.5 mg · kg- 1. Both ulnar nerves were stimulated with TOF every 12 sec until one per cent recovery of first twitch (T1). At this time, ST stimulation was applied to one arm, selected at random. When the mean value of T1 and ST reached ten per cent of control, edrophonium, 1 mg · kg- 1, preceded by atropine was given either as a single dose, or in two doses consisting of 0.2 mg · kg- 1 followed by 0.8 mg · kg- 1 three minutes later. No statistically significant differences were observed between T1 and ST for the next ten minutes, whether edrophonium had been given in single or divided doses. Giving edrophonium in divided doses did not improve recovery significantly, measured with either T1, ST or train-of-four ratio (T4/T1). Five minutes after the first administration of edrophonium, T1 was (mean ± SEM) 86 ± 3 and 86 ± 2 per cent control in the single and divided dose groups respectively. Corresponding values for ST were 89 ± 1 and 89 ± 2 per cent (NS), and for TOF, 49 ± 3 and 57 ± 3 per cent (NS), respectively. At ten minutes, values of T1 ST and T4/T1 were 98 ± 1,96 ± 1 and 64 ± 3 per cent respectively in the single dose group, not significantly different from the corresponding values in the divided group (95 ± 2, 96 ± 1 and 68 ± 3 per cent). It is concluded that giving edrophonium in divided doses, i.e., «priming” does not accelerate reversal of atracurium-induced neuromuscular blockade. Furthermore, in the assessment of edrophonium antagonism, the first twitch response to TOF stimulation is equivalent to single twitch response.
Résumé
On a dejà decrit une neutralisation plus rapide du bloc neuromusculaire en séparant la dose d’édrophonium (un effet d’amorce). Parce que le type de stimulation peut changer la mesure de la rapidité de l’effet, on a utilisé le train-de-quatre (TDQ) el la stimulation unique (SU) simultanément. On a donné 0,5 mg · kg- 1 d’atracurium à 20 sujets adultes anesthésiés au thiopental, protoxyde d’azote et enflurane. On a stimulé en TDQ le nerf cubital de chaque cote toutes les 12 secondes. Lorsque le premier élément du TDQ (T1) atteignait un pour cent, on a substitué la SU au TDQ pour un cote choisi au hasard. Lorsque la moyenne de T1 et la reponse à la SU atteignait dix pour cent, on a injecté de l’edrophonium soit en une seule dose de 1,0 mg · kg- 1, soit en une dose de 0,2 mg · kg- 1 suivie, trois minutes plus tard, de 0,8 mg · kg- 1. Le T1 ne s’écartait pas significativement de SU, que l’édrophonium ait été donne en une ou deux doses. L’administration d’édrophonium en deux doses ne produisait pas une meilleure récupération, que celle-ci soit mesuree en termes de T1, de SU ou de rapport du TDQ (T4T1). Cinq minutes aprés la première injection d’édrophonium, le T1 s’élevait à (moyenne ± ETM) 86 ± 3 et 86 ± 2 pour cent de la valeur contrôle après une dose unique et séparée, respectivement. Les valeurs correspondantes de SU étaient de 89± 1 et 89 ± 2 pour cent respectivement (NS). Pour le TDQ, elles étaient de 49 ± 3 et 57 ± 3 pour cent (NS) respectivement. Apres dix minutes, le T1 SU et T4/T1 etaient de 98 ± 1, 96 ± 1 et 64 ± 3 pour cent respectivement chez les malades ayant reçu une dose unique, et de 95 ± 2, 96 ± 1 et 68± 3 pour cent les sujets ayant eu une dose séparée (differences non-significatives dans tous les cas). On en conclut que l’administration d’ édrophonium en doses séparées (l’amorce) n’accelére pas la neutralisation du bloc neuromusculaire produit par l’atracurium. De plus, dans l’évaluation de l’effet de l’édrophonium, le premier élément du TDQ équivaut à la réponse à la stimulation unique.
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Szalados, J.E., Donati, F. & Bevan, D.R. Edrophonium priming for antagonism of atracurium neuro-muscular blockade. Can J Anaesth 37, 197–201 (1990). https://doi.org/10.1007/BF03005469
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DOI: https://doi.org/10.1007/BF03005469