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Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by rapacuronium, rocuronium and cisatracurium, but not mivacurium

[L’édrophonium antagonise efficacement le blocage neuromusculaire des adducteurs laryngés induit par le rapacuronium, le rocuronium et le cisatracurium, mais non par le mivacurium]

From the Department of Anesthesiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA.

Address correspondence to: Dr. Takahiro Suzuki, 3-24-3, Asagaya-Kita, Suginami-Ku, Tokyo 166-0001, Japan. Phone: +81-3-3336-0428; Fax: +81-3-3336-0428; E-mail: suzukit{at}cd5.so-net.ne.jp

Purpose: To examine the efficacy of antagonism of rapacuronium-, mivacurium-, rocuronium- and cisatracurium-induced neuromuscular block at the laryngeal adductors (LA).

Methods: One hundred four patients were randomly assigned to one of eight study groups. They either received rapacuronium 1.5 mg•kg^-1, mivacurium 0.25 mg•kg^-1, rocuronium 0.9 mg•kg^-1 or cisatracurium 0.15 mg•kg^-1. Patients in each treatment group either received edrophonium (0.5 mg•kg^-1) at 10% recovery of the first twitch (T1) of train-of-four (TOF) at the LA or were allowed to recover spontaneously from neuromuscular block. The effect of antagonism on speed of recovery of neuromuscular function at the LA was evaluated.

Results: The time to recovery to a TOF ratio of 0.9 at the LA, when compared to the spontaneous recovery group, was significantly shortened by the administration of edrophonium in patients receiving rapacuronium [19.2 ± 7.8 vs 26.2 ± 4.9 (mean ± SD) min], rocuronium (24.7 ± 14.3 vs 44.4 ± 13.0 min) and cisatracurium (24.2 ± 5.7 vs 35.1 ± 7.6 min). Edrophonium administration did not shorten complete recovery from mivacurium-induced block (15.7 ± 8.0 vs 17.6 ± 6.1 min).

Conclusion: Recovery from rapacuronium-, rocuronium- or cisatracurium- induced neuromuscular block to a TOF ratio of 0.9 as measured at the LA was shortened by the administration of edrophonium, when compared to spontaneous recovery.

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