Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Edrophonium priming alters the course of neuromuscular recovery from a pipecuronium neuromuscular blockade

  • 159 Accesses

Abstract

This study was designed to investigate the effect of divided administration of edrophonium on the course of neuromuscular recovery from a pipecuronium neuromuscular blockade. During thiopentone-nitrous oxide-halothane anaesthesia 48 patients were given pipecuronium 70 μg · kg−1. Patients were randomly assigned to one of four groups (n = 12 in each) to receive either edrophonium 1 mg · kg−1 (Groups I and II) or edrophonium 0.75 mg · kg−1 (Groups III and IV). In Groups I and III (single-dose groups), edrophonium was administered as a single bolus dose. In Groups II and IV (divided-dose groups) edrophonium was administered as an initial dose of 0.25 mg · kg−1 followed three minutes later by either 0.75 or 0.50 mg · kg−1 respectively. Reversal was attempted at 20% spontaneous recovery of twitch height. Administration of edrophonium in divided doses (Groups II and IV) accelerated the reversal of the pipecuronium neuromuscular blockade. At ten minutes post-reversal, train-of-four (TOF) ratio recovery reached 0.75 or more in 12 (100%) and in ten (83%) patients in Groups II and IV respectively. Similarly, times to attain a TOF of 0.75 (SEM) were shorter in the divided-dose groups than in the single-dose groups (P < 0.05), being 354.5 (38.7) and 398.3 (49.1) sec in Groups II and IV vs 705.4 (66.6) and 651.2 (54.3) sec in Groups I and III respectively. Time was counted from the first administration of edrophonium. It is concluded that administration of edrophonium in divided doses produced a faster reversal of residual pipecuronium-induced neuromuscular blockade than single bolus administration. Also, administration in divided doses reduced the requirements of edrophonium needed for reversal of pipecuronium neuromuscular blockade.

Résumé

Nous avons voulu évaluer l’effet de la fragmentation de doses d’édrophonium injectées pendant la phase de récupération d’un bloc neuromusculaire au pipécuronium. Nous injections d’abord à 48 patients, randomisés en quatre groupes de 12, 70 μg · kg−1 de pipécuronium lors d’une aneslhésie au thiopental, protoxyde d’azote et halothane. Lorsque la force de contraction atteignait 20% de la valeur contrôle lors de sa récupération spontanée, nous injections de l’édrophonium selon le protocole suivant. Aux patients des groupes I et II, nous en injections 1 mg · kg−1 et à ceux des groupes III et IV, 0,75 mg · kg−1. Pour les patients des groupes I et III, l’injection se faisait d’un seul coup, tandis que pour ceux des groupes III et IV, on injectait d’abord 0,25 mg · kg−1 suivi du reste de la dose trois minutes plus tard. La fragmentation de la dose d’édrophonium entraîna une récupération plus rapide de la force de contraction musculaire (à partir de l’injection de la fraction initiale). Ainsi, dix minutes post injection, le ratio du train-de-quatre ondes (TOF) dépassait 0,75 chez 12 (100%) et chez dix (83%) des patients des groupes II et IV. D’ailleurs, le temps de latence avant d’arriver à un ratio de 0,75 était en moyenne plus court chez les patients à dose fractionnée que chez les autres (P < 0,05) soit 354,5 (erreur type: 38,7) et 398,3 (49,1) secondes pour les groupes II et IV d’une part et 705,4 (66,6) et 651,2 (54,3) secondes pour les groupes I et III d’autre part. Dans un contexte de bloc neuromusculaire résiduel au pipécuronium, la fragmentation de la dose d’édrophonium utilisée comme antidote en augmente l’efftcacité et en accélère l’action.

References

  1. 1

    Boros M, Szenohradszky J, Kertesz A, Marosi GY, Tutsek L. Clinical experiences with pipecuronium bromide. Acta Chir Hung 1983; 24: 207–14.

  2. 2

    Wierda JMKH, Richardson FJ, Agoston S. Dose-response relation and time course of action of pipecuronium bromide in humans anesthetized with nitrous oxide and isoflurane, halothane, or dropertdol and fentanyl. Anesth Analg 1989; 68: 208–13.

  3. 3

    Abdulatif M, Naguib M. Neostigmine and edrophonium for reversal of pipecuronium neuromuscular blockade. Can J Anaesth 1991; 38: 159–63.

  4. 4

    Naguib M, Abdulatif M, Absood GH. Accelerated reversal of atracurium blockade with priming doses of edrophonium. Anesthesiology 1987; 66: 397–400.

  5. 5

    Naguib M, Abdulatif M. Priming with anticholinesterases —the effect of different combinations of anticholinesterases and different priming intervals. Can J Anaesth 1988; 35: 47–52.

  6. 6

    Naguib M, Abdulatif M. Priming with anticholinesterases —the effect of different priming doses of edrophonium. Can J Anaesth 1988; 35: 53–7.

  7. 7

    Naguib M. Train-of-four ratio after antagonism of atracurium with edrophonium: influence of different priming doses of edrophonium. Can J Anaesth 1989; 36: 25–9.

  8. 8

    Abdulatif M, Naguib M. Accelerated reversal of atracurium blockade with divided doses of neostigmine. Can Anaseth Soc J 1986; 33: 723–8.

  9. 9

    Viby-Mogensen J. Clinical assessment of neuromuscular transmission. Br J Anaesth 1982; 54: 209–23.

  10. 10

    Ali HH, Kitz RJ. Evaluationof recovery from nondepolarizing neuromuscular block using a digital neuromuscular transmission analyzer: preliminary report. Anesth Analg 1973; 52: 740–5.

  11. 11

    Donati F, Smith CE, Wiesel S, Bevan DR. “Priming” with neostigmine: failure to accelerate reversal of single twitch and train-of-four responses. Can J Anaesth 1989; 36: 30–4.

  12. 12

    Szalados JE, Donati F, Bevan DR. Edrophonium priming for antagonism of atracurium neuromuscular blockade. Can J Anaesth 1990; 37: 197–201.

  13. 13

    Magorian TT, Lynam DP, Caldwell JE, Miller RD. Can early administration of neostigmine, in single or repeated doses, alter the course of neuromuscular recovery from a vecuronium-induced neuromuscular blockade? Anesthesiology 1990; 73: 410–4.

  14. 14

    Delisle S, Bevan DR. Impaired neostigmine antagonism of pancuronium during enflurane anaesthesia in man. Br J Anaesth 1982; 54: 441–5.

  15. 15

    Dernovoi B, Agoston S, Baurain M, Lefebvre R, d’Hollander A. Neostigmine antagonism of vecuronium paralysis during fentanyl, isoflurane, and enflurane anesthesia. Anesthesiology 1987; 66: 698–701.

  16. 16

    Miller RD, Way WL, Donlan WM, Stevens WC, Eger IIEI. The dependence of pancuroniumand dtubocurarine-induced neuromuscular blockades on alveolar concentrations of halothane and forane. Anesthesiology 1972; 37: 573–81.

  17. 17

    Donati F, Smith CE, Bevan DR. Dose-response relationships for edrophonium and neostigmine as antagonists of moderate and profound atracurium blockade. Anesth Analg 1989; 68: 13–9.

  18. 18

    Barber HE, Calvey TN, Muir KT. The relationship between the pharmacokinetics, cholinestrase inhibition and facilitation of twitch tension of the quaternary ammonium anticholinesterase drugs neostigmine, pyridostigmine, edrophonium and 3-hydrophenyltrimethylammonium. Br J Pharmacol 1979; 66: 525–30.

Download references

Author information

Correspondence to Mohamed Naguib.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Naguib, M., Abdulatif, M. Edrophonium priming alters the course of neuromuscular recovery from a pipecuronium neuromuscular blockade. Can J Anaesth 38, 722–727 (1991). https://doi.org/10.1007/BF03008449

Download citation

Key words

  • antagonists, neuromuscular relaxants: edrophonium
  • monitoring, neuromuscular: train-of-four
  • neuromuscular relaxants: pipecuronium
  • pharmacodynamics: priming principle