EDROPHONIUM ANTAGONISM OF VECURONIUM AT VARYING DEGREES OF 4TH TWITCHRECOVERY

Citation
Ym. Salib et al., EDROPHONIUM ANTAGONISM OF VECURONIUM AT VARYING DEGREES OF 4TH TWITCHRECOVERY, Canadian journal of anaesthesia, 40(9), 1993, pp. 839-843
Citations number
12
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Anesthesiology
ISSN journal
0832-610X
Volume
40
Issue
9
Year of publication
1993
Pages
839 - 843
Database
ISI
SICI code
0832-610X(1993)40:9<839:EAOVAV>2.0.ZU;2-U
Abstract
The purpose of this study was to determine the optimal dose of edropho nium needed for successful antagonism (train-of-four ratio, or T4/T1 > 0.7) of vecuronium-induced blockade when all four twitches were visib le in response to indirect train-of-four (TOF) stimulation. Forty pati ents, scheduled for elective surgical procedures not exceeding 120 min , received vecuronium, 0.08 mg-kg-1, during thiopentone-N2O-isoflurane anaesthesia. Train-of-four stimulation was applied every 20 sec and t he force of contraction of the adductor pollicis muscle was recorded I ncrements of vecuronium, 0.015 mg . kg-1, were given as required. At t he end of surgery, and provided that neuro-muscular activity had recov ered to four visible twitches, edrophonium, 0.1 mg . kg-1, was given. Two minutes later, edrophonium, 0.1 mg . kg-1, was given if T4/T1 did not reach 0.7. After another two minutes, edrophonium, 0.2 mg . kg-1, was given if T4/T1 did not reach 0.7 or more. Finally, if T4/T1 was st ill < 0.7, a dose of 0.4 mg . kg-1 way given. Seventeen patients (42.5 %) required 0.1 mg . kg-1 of edrophonium for successful reversal, sixt een patients (40%) needed a cumulative dose of 0.2 mg . kg-1 and six p atients (15%) required 0.4 mg . kg-1. Only one patient received 0.8 mg . kg-1. There was a good correlation between T4/T1 two minutes after the first dose of edrophonium and pre-reversal T4/T1 (r = 0.6, P = 0.0 0014). All patients with pre-reversal T4/T1 > 0.23 required at most 0. 2 mg . kg-1 of edrophonium for successful reversal. We conclude that w hen all four twitches are clearly visible following train-of-four stim ulation, small doses of edrophonium (0.1-0.2 mg . kg-1) might be suffi cient to antagonize vecuronium neuromuscular blockade.