CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lessard, M. R.
Right arrow Articles by Rouillard, J. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lessard, M. R.
Right arrow Articles by Rouillard, J. F.

Canadian Journal of Anesthesia, Vol 44, 836-842, Copyright © 1997 by Canadian Anesthesiologists' Society

ARTICLES

Neostigmine requirements for reversal of neuromuscular blockade following an infusion of mivacurium

MR Lessard, CA Trepanier and JF Rouillard
Departement d'anesthesie-reanimation, Hopital de l'Enfant-Jesus, Quebec, Canada. martin.lessard@anr.ulaval.ca

PURPOSE: To study the efficacy of neostigmine compared with placebo for the antagonism of neuromuscular blockade at the end of a mivacurium infusion, and to determine its optimal dose. METHODS: One hundred adult patients undergoing an elective surgical procedure received a standardized anaesthetic with 20-30 micrograms.kg-1 alfentanil, a propofol infusion and nitrous oxide. Muscle relaxation was maintained at 90-95% T1 depression with 0.2 mg.kg-1 mivacurium followed by an infusion. Neuromuscular blockade was measured with an integrated evoked electromyogram in response to train-of-four (TOF) stimuli at the ulnar nerve every 20 sec. Patients were randomized into four groups. At the end of surgery, the mivacurium infusion was stopped and patients received, immediately, in a double-blind manner, neostigmine (10, 20, or 40 micrograms.kg-1) or placebo according to a random number table. The T1 and TOF ratio were recorded until adequate recovery of neuromuscular function (TOF ratio > 0.70). During the reversal period, non-invasive blood pressure and heart rate were recorded every minute. The incidence of postoperative nausea and vomiting (PONV) was recorded in the recovery room. RESULTS: Data from 94 patients who completed the protocol were analysed. Compared with placebo, neostigmine 10 micrograms.kg-1 did not reduce the time to TOF > 0.70 (17.0 +/- 5.1 vs 14.6 +/- 4.2 min respectively). However the time was decreased with neostigmine 20 micrograms.kg-1 and 40 micrograms.kg-1 (P < 0.001), but with no difference between these last two groups (11.4 +/- 3.0 and 11.4 +/- 3.5 min respectively). Changes in systolic blood pressure and heart rate were not different between the four groups. Very few PONV events were observed in all groups (global incidence 7.4%). CONCLUSION: Recovery of neuromuscular blockade following a mivacurium infusion is accelerated by neostigmine. A dose of neostigmine 20 micrograms.kg-1 appears optimal with no further reduction in recovery time obtained from a larger dose.




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1997 by the Canadian Anesthesiologists' Society.