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Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1074–1081 | Cite as

Dose-response relationships for edrophonium and neostigmine antagonism of atracurium and cisatracurium- induced neuromuscular block

  • Mohamed Naguib
  • Waleed Riad
Reports Of Investigation

Abstract

Purpose: To study the dose-response relationships for neostigmine and edrophonium during antagonism of neuromuscular block induced by atracurium and cisatracurium.

Methods: One hundred and twenty eight, ASA group 1 or 2 adults were given either 0.5 mg·kg−1 atracurium or 0.1 mg·kg−1 cisatracurium during fentanyl-thiopental-nitrous oxide-isoflurane anesthesia. The neuromuscular block was measured by an acceleration-responsive transducer. Responses were defined in terms of percent depression in the first twitch (TI) and train-of-four (TOF) response. When spontaneous recovery of first twitch height reached 10% of its initial control value, edrophonium (0.1, 0.2, 0.4, or 1 mg·kg−1) or neostigmine (0.005, 0.01, 0.02, or 0.05 mg·kg−1) was administered by random allocation. Neuromuscular function in another sixteen subjects was allowed to recover spontaneously.

Results: At five minutes, unlike edrophonium, neostigmine was equally effective against atracurium and cisatracurium with respect to TI recovery. The neostigmine TI-ED50 was 10.3±1.06 (SEM) µg·kg−1 after atracurium and 11.2±1.06) µg·kg−1 after cisatracurium. The edrophonium ED50 was 157±1.07 µg·kg−1 with atracurium and 47.4±1.07 µg·kg−1 with cisatracurium, giving a neostigmine:edrophonium potency ratios of 15.2±1.7 and 4.2±0.41 (P<0.001) for atracurium and cisatracurium, respectively. At 10 min neostigmine was 13±1.4 times as potent as edrophonium for achieving 50% TOF recovery after atracurium paralysis. After cisatracurium the potency ratio was 11.8±1.3 (NS).

Conclusions: Although there were differences at five minutes, neostigmine:edrophonium potency ratios at 10 min, were similar in both relaxants studied.

Keywords

Rocuronium Neostigmine Neuromuscular Blockade Atracurium Neuromuscular Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Étudier les relations doses-réponses de la néostigmine et de l’édrophonium pendant le renversement du bloc neuromusculaire induit par l’atracurium et le cisatracurium.

Méthode: Cent vingt-huit adultes, d’état physique ASA I ou II, ont reçu, soit 0,5 mg·kg−1 d’atracurium, soit 0,1 mg·kg−1 de cisatracurium pendant l’anesthésie au fentanyl-thiopental-protoxyde d’azote-isoflurane. Le bloc neuromusculaire a été mesuré par un transducteur sensible à l’accélération. Les réponses ont été définies en termes de pourcentage de dépression lors de la réponse à la première stimulation (T1) et au train-de-quatre (TDQ). Au moment où la récupération spontanée à la première stimulation a atteint 10 % de la valeur témoin initiale, de l’édrophonium (0,1; 0,2; 0,4 ou 1 mg·kg−1) ou de la néostigmine (0,005; 0,01; 0,02 ou 0,05 mg·kg−1) a été administrée selon une affectation aléatoire. Chez seize autres sujets, on a laissé la fonction neuromusculaire se rétablir spontanément.

Résultats: À cinq minutes, contrairement à l’édrophonium, la néostigmine a été également efficace contre l’atracurium et le cisatracurium quant à la récupération à T1. La T1-ED50 de la néostigmine était de 10,3±1,06 (erreur type) µg·kg−1 après l’atracurium et de 11,2±1,06 µg·kg−1 après le cisatracurium. La ED50 de l’édrophonium était de 157±1,07 µg·kg−1 avec l’atracurium et de 47,4±1,07 µg·kg−1 avec le cisatracurium, ce qui donnait des coefficients de puissance néostigmine:édrophonium de 15,2±1,7 et de 4,2±0,41 (P<0,001) pour l’atracurium et le cisatracurium, respectivement. À 10 min, la néostigmine était 13±1,4 fois aussi puissante que l’édrophonium pour atteindre 50 % de récupération du TDQ après la paralysie avec l’atracurium. Après l’utilisation de cisatracurium, le coefficient de puissance était de 11,8±1,3 (NS).

Conclusion: Même s’ils étaient différents à cinq minutes, les coefficients de puissance néostigmine:édrophonium ont été similaires à 10 min avec les deux relaxants étudiés.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  1. 1.King Saud UniversitySaudi Arabia
  2. 2.Department of AnesthesiaUniversity of Iowa College of MedicineIowa CityUSA

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