Abstract
This study was designed to investigate the effect of different combinations of neostigmine and edrophonium when administered in divided doses and the effect of different intervals (priming intervals) between the doses. Seventy-two patients divided into 12 groups (n = 6 in each) were included in the study. An initial dose of neostigmine 0.012 mg-kg-1 or edrophonium 0.2 mg-kg-1 was administered, followed at different priming intervals (1, 2 or 3 min) by either edrophonium 0.8 mg-kg-1 or neostigmine 0.048 mg-kg-1 for antagonism of atracurium-induced neuromuscular blockade. Reversal was attempted at 10 per cent spontaneous recovery of twitch height. Adequate reversal of neuromuscular block (train-of-four ratio of 0.75) was achieved in all patients. Significant (p < 0.05) acceleration of the recovery index (time taken for the twitch height to recover from 25 to 75 per cent of control) and reversal time (time taken from the end of injection of the priming dose until TOF ratio value had reached 0.75) was obtained in groups which received edrophonium-edrophonium combination. Recovery indices and reversal times were found to be significantly shorter (p < 0.05) with a 1 min priming interval.
In two additional groups of patients premedicated and anaesthetized as the others equipotent mixtures of the antagonists were administered as a single bolus dose. Reversal times were significantly longer (p < 0.05) when compared to those given the same amounts of the combination but in divided doses with a 1 min priming interval.
It is concluded that the administration of edrophonium in divided doses (0.2 mg-kg-1 followed one minute later by 0.8 mg-kg-1) is the best combination of those studied for the antagonism of profound (90 per cent depression of TJ) neuromuscular blockade induced by atracurium. With this technique of administration, a TOF ratio of 0.75 can be obtained in about 4 min.
Résumé
La présente étude a été conçue afin ďinvestiguer les effets de différentes combinaisons de néostigmine et ďédrophonium lorsqu’administrés en doses fractionnées ainsi que ľeffet des différents intervals (interval ďamorce) entre les doses. Soixante-douze patients divisés en 12 groupes (n = 6 pour chaque groupe) ont été inclus dans ľétude. Une dose initiale de néostigmine 0.012 mg-kg-1 ou ďédrophonium 0.2 mg-kg-1 a été administrée suivie, à des intervals ďamorce différents (1,2 ou 3 minutes), par soit ľédrophonium 0.8 mg-kg-1 ou la néostigmine 0.048 mg-kg-1 afin ďantagoniser le blocage neuromusculaire induit par ľatracurium. La décurarisation a été tentée après une récupération spontanée de dix pour cent de la hauteur du twitch. Un antagonisme adéquat du bloc neuromusculaire (rapport de ľondée-de-quatre (TOF) de 0.75) a été obtenu chez tous les patients. Une accélération significative (p < 0.05) de ľindice de recouvrement (temps pris pour que la hauteur du twitch retourne de 25 à 75 pour cent du contrôle) et le temps ďantagonisme (temps pris à partir de la fin de ľinjection de la dose ďamorce jusqu’à ľobtention ďun rapport TOF de 0.75) ont été obtenus dans les groupes avant reçu la combinaison ďédrophoniumédrophonium. Les indices de récupération et les temps ďantagonisme ont été trouvés significativement plus courts (p < 0.05) après une minute ďinverval ďamorce.
Dans deux groupes additionnels de patients prémédiqués et anesthésiés comme les autres, des mélanges équipotents ďantagonistes ont été administrés en une dose unique. Les temps ďantagonisme ont été trouvés significativement plus longs (p < 0.05) en comparaison à ceux qui ont reçu la même quantité de mélanges en doses fractionnées avec un interval ďamorce de une minute.
Il est conclut que I’administration ďédrophonium à doses fractionnées (0.2 mg-kg-1 suivi une minute plus tard par 0.8 mg-kg-1) est la meilleure combinaison pour le groupe étudié afin ďantagoniser un bloc neuromusculaire profond (une dépression de 90 pour cent de 77) induit par ľatracurium. Avec cette technique ďadministration un rapport TOF de 0.75 peut être obtenu dans approximativement quatre minutes.
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Naguib, M., Abdulatif, M. Priming with anticholinesterases — the effect of different combinations of anticholinesterases and different priming intervals. Can J Anaesth 35, 47–52 (1988). https://doi.org/10.1007/BF03010544
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DOI: https://doi.org/10.1007/BF03010544