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Interaction of verapamil with atracurium and reversal of combined neuromuscular blockade with edrophonium and neostigmine


In this study, we have demonstrated, in rat phrenic nerve hemidiaphragm preparation, that (a) verapamil (2.2–220 μM) potentiated atracurium (0.8–80 μM)-induced neuromuscular blockade, by enhancing atracurium-induced depression of indirect twitch tension, by 35–45%, (b) neostigmine (60 nM) and edrophonium (50 nM) both effectively (by 18±2% and 25±1%, respectively, means ± S.E., n = 6, P< 0.05, P< 0.01) reversed atracurium and atracurium-verapamil blockade, with no significant difference between the reversals of the latter two blockades, and (c) verapamil may act at both pre- and postjunctional sites at the rat neuromuscular junction.

It was concluded that verapamil, by acting at both pre- and postjunctional membranes, enhanced atracurium-induced neuromuscular blockade and that the combined atracurium-verapamil blockade can be easily reversed with anti-cholinesterase agents.

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Wali, F.A., McAteer, E. & Suer, A.H. Interaction of verapamil with atracurium and reversal of combined neuromuscular blockade with edrophonium and neostigmine. I.J.M.S. 156, 215 (1987).

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  • Verapamil
  • Neostigmine
  • Neuromuscular Blockade
  • Atracurium
  • Edrophonium