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Canadian Journal of Anesthesia, Vol 30, 575-580, Copyright © 1983 by Canadian Anesthesiologists' Society

Neostigmine Antagonism of Succinylcholine Phase II Block: a Comparison with Pancuronium

MALCOLM E. FUTTER MB BS FFARCS1, FRANÇOIS DONATI PHD MD1, A. S. SADIKOT BA1, and DAVID R. BEVAN MB B CHIR MRCP FFARCS1

1 Departments of Anaesthesia, Royal Victoria Hospital & McGill University, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1

Address correspondence to: Dr. D.R. Bevan, Department of Anaesthesia, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, Que., H3A 1A1.

To assess the efficacy of neostigmine antagonism of succinylcholine phase II block, succinylcholine infusions were given to 17 patients for durations varying from 44 to 192 minutes. A control group (17 patients) received a pancuronium infusion for similar times. Ninety per cent neuromuscular block was maintained in these two groups by adjustment of the infusion rates and, in a third group, with intermittent doses of pancuronium. Neuromuscular transmission was monitored with train-of-four stimulation every 12 seconds and anaesthesia was maintained with N2O-O2-enflurane. Ten minutes after the infusion was stopped, atropine and neostigmine were given to all patients who received pancuronium and to 11 patients in the succinylcholine group whose train-of-four ratio (T4|T1) was less than 0.7. During the subsequent 15 minutes, recovery was more rapid in the succinylcholine group than in either the pancuronium-infusion or pancuronium-bolus groups. It is concluded that succinylcholine-induced phase II block can be safely and rapidly antagonized with neostigmine.

Key Words: ANTAGONISTS: neostigmine • NEUROMUSCULAR RELAXANTS: succinylcholine, pancuronium, phase II block






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Copyright © 1983 by the Canadian Anesthesiologists' Society.