1.The Effects of Divided Doses of Neostigmine on Reversal of Vecuronium Block.
Young Seok LEE ; Jin Su KIM ; Jong Rae KIM
Korean Journal of Anesthesiology 1990;23(1):47-50
The hypothesis that administration of neostigmine in divided doses might accelerate the antagonism of nuromuscular blockade was investigated. Neostigmine 0.05mg/kg was adminsitered either in a single bolus dose (Group I, n=10) or in an initial dose of 0.01 mg/kg 1 minute later (Group II, n=10), 2 minutes later (Group III, n=10) and 3 minutes later (Group IV, n=10) for antagonism of vecuronium- induced blockade. Reversal was attepted at 10 percent spontaneous recovery of twitch height. The mean time (+/-SE) from the first injection of the drug until the train-of-four(TOF) ratio value had reached 0. 75 was signifincantly longer in Group II and IV (594.8+/-63.9 seconds and 555.6+/-22.2 seconds respectively) than Group I and III (380.6+36.0 seconds and 357.8+/-44.2 seconds respectively). It is concluded that adminstration of neostigmine in divided doses with 0. 01 mg/kg and 0.04 mg/kg did not produce a significantly faster reversal of residual vecuronium-induced neuromuscular blockade as compared to a single bolus administration.
Neostigmine*
;
Neuromuscular Blockade
;
Vecuronium Bromide*
2.Pulse Rate Changes after Increased Doses of Glycopyrrolate in Combination with Neostigmine.
Soon Gyu PARK ; Soon Yong HONG ; Kiu Sam KIM
Korean Journal of Anesthesiology 1987;20(6):751-755
Glycopyrrolate is frequently administered in combination with neostigmine to reverse a neuromus- cular blockade. The dosage was well established at 1/5 of neostigmine. But the authers have often observed a delayed manifestation of relative bradycardia after such a recommended dosage. This is not mentioned in the literature, but this may be due to an insufficient observation period. The authors monitored the change of pulse rate for 1 hour after the administration of the recom. mended dose. Further, the data wIns compared with that obtained after studies of lower and higher doses. The doses were 0.004, 0.008 and 0.012mg/kg of glycopyrrolate with 0.04mg/kg of neostigmine. 1) At all doses, bradycardia relative to the pre-reversal pulse rate was progressive until 30 minutes after injection. 2) As the glycopyrrate dose was increased the degree of bradycardia decreased (-24.7, -20.5, - 15.0 at 30 min.). 3) There was no difference in the immediate change in the pulse rate between the dcsages of 0.008 and 0.012 mg/kg. Change occured at 9 mins. 4) At dosages of 0.004 and 0.008 mg/kg, the pulse rates at 60 min were comparable to their ward pulses, but at a dosage of 0.012 mg/kg, the pulse rate was 8.5 beats/min higher.
Bradycardia
;
Glycopyrrolate*
;
Heart Rate*
;
Neostigmine*
3.The combination of sugammadex and neostigmine can reduce the dosage of sugammadex during recovery from the moderate neuromuscular blockade.
Soon Ho CHEONG ; Seunghee KI ; Jiyong LEE ; Jeong Han LEE ; Myoung Hun KIM ; Dongki HUR ; Kwangrae CHO ; Se Hun LIM ; Kun Moo LEE ; Young Jae KIM ; Wonjin LEE
Korean Journal of Anesthesiology 2015;68(6):547-555
BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the reversal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. METHODS: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 microg/kg + glycopyrrolate 10 microg/kg, N - neostigmine 50 microg/kg + glycopyrrolate 10 microg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was 182.6 +/- 88.9, 371.1 +/- 210.4, 204.3 +/- 103.2, 953.2 +/- 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of sugammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.
Glycopyrrolate
;
Humans
;
Hypersensitivity
;
Incidence
;
Neostigmine*
;
Neuromuscular Blockade*
4.A Case of Prolonged Paresis following GaIIamine on Reoperation Patient .
Sung Ja LEE ; Young Sok CHOI ; Young Hyuk KIM ; Jung Soon SHIN
Korean Journal of Anesthesiology 1975;8(1):97-99
The authors have experience of a case of prolonged paresis following administration of galamine triethiodide to a patient undergoing reoperation. The muscular weakness continued for 20 hours, necessitating artificial ventilation intermittently. It was reversed by neostigmine.
Humans
;
Muscle Weakness
;
Neostigmine
;
Paresis*
;
Reoperation*
;
Ventilation
5.The Time of Neostigmine Antagonism for the Rapid Recovery of Profound Muscle Relaxation in Rabbits.
Yoon Kee KIM ; Seon Eek HWANG ; Kyo Sang KIM ; Se Ung CHON
Korean Journal of Anesthesiology 1996;30(5):534-541
BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.
Atropine
;
Muscle Relaxation*
;
Neostigmine*
;
Pancuronium
;
Rabbits*
;
Relaxation
6.Neuromuscular Elock by Vecuronium and Neostigmine Effect in Hypothermic Rabbits .
Hae Soon KIM ; Dong Ho LEE ; Kyoung Hun KIM ; Kyo Sang KIM ; Jung Kook SUH ; Hee Koo YOO ; Ik Sang SEUNG ; Se Ung CHON
Korean Journal of Anesthesiology 1987;20(4):470-476
Anesthesiologists may have close relationship with muscle relaxants in clinioal practice. Fortunately, few of the new muscle relaxants were discovered and used in clinic recently. And also hypothermia reduced the effectiveness and prolonged duration of non-depolarizing b1ock, has been challenged, and it is now generally accepted that hypothermia prolongs the duration of non-depolarizing neuromuscular block. But exactly how much b1ock mar prolonged is not mentioned so there may exist controversial result from animal to animal. We have studied newly introduced vecuronium effects during hypothermic rabbits. The results were as follows ; 1. Spontaneous recovery index by vecuronium 7.05 mg/kg in normothermic rabbit was 216.4 sec(3.6 min). 2. Spontaneous recovery index by vecuronium 0.05 mg/kg in hypothermic (32degrees C) rabbit was markedly prolonged as 441.3 sec(7.35 min) . 3. Recovery index by the neostigmine 40 ug/kg reversal in hypothermic(32degrees C) rabbit was 120.1 sec(2.0min). Authors concluded that vecuronium effects on hypothermic rabbits were markedly prolo- nged and promptly reversed.
Animals
;
Hypothermia
;
Neostigmine*
;
Neuromuscular Blockade
;
Rabbits*
;
Vecuronium Bromide*
7.Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients.
Tiffany WOO ; Kyo Sang KIM ; Yon Hee SHIM ; Mi Kyeong KIM ; Suk Min YOON ; Young Jin LIM ; Hong Seuk YANG ; Phillip PHIRI ; Jin Young CHON
Korean Journal of Anesthesiology 2013;65(6):501-507
BACKGROUND: Rapid and complete reversal of neuromuscular blockade (NMB) is desirable at the end of surgery. Sugammadex reverses rocuronium-induced NMB by encapsulation. It is well tolerated in Caucasian patients, providing rapid reversal of moderate (reappearance of T2) rocuronium-induced NMB. We investigated the efficacy and safety of sugammadex versus neostigmine in Korean patients. METHODS: This randomized, safety assessor-blinded trial (NCT01050543) included Korean patients undergoing general anesthesia. Rocuronium 0.6 mg/kg was given prior to intubation with maintenance doses of 0.1-0.2 mg/kg as required. Patients received sugammadex 2.0 mg/kg or neostigmine 50 microg/kg with glycopyrrolate 10 microg/kg to reverse the NMB at the reappearance of T2, after the last rocuronium dose. The primary efficacy endpoint was the time from sugammadex or neostigmine administration to recovery of the train-of-four (TOF) ratio to 0.9. The safety of these medications was also assessed. RESULTS: Of 128 randomized patients, 118 had evaluable data (n = 59 in each group). The geometric mean (95% confidence interval) time to recovery of the TOF ratio to 0.9 was 1.8 (1.6, 2.0) minutes in the sugammadex group and 14.8 (12.4, 17.6) minutes in the neostigmine group (P < 0.0001). Sugammadex was generally well tolerated, with no evidence of residual or recurrence of NMB; four patients in the neostigmine group reported adverse events possibly indicative of inadequate NMB reversal. CONCLUSIONS: Sugammadex was well tolerated and provided rapid reversal of moderate rocuronium-induced NMB in Korean patients, with a recovery time 8.1 times faster than neostigmine. These results are consistent with those reported for Caucasian patients.
Anesthesia, General
;
Glycopyrrolate
;
Humans
;
Intubation
;
Neostigmine*
;
Neuromuscular Blockade*
;
Recurrence
8.The Effects of Succinylcholine on Mivacurium: induced Neuromuscular Blockade and its Reversal in Cats.
Eun Chi BANG ; Yang Sik SHIN ; Kyung HUH
Korean Journal of Anesthesiology 1996;30(2):131-138
BACKGROUND: Previous studies examining the pharmacodynamic effects of succinylcholine(SCC) on subsequent doses of nondepolarizing muscle relaxants showed potentiation with resultant prolonged respiratory depression or no interaction at all. The interaction between SCC and mivacurium especially has not been investigated in animal and other clinical studies. METHODS: The pharmacodynamic effects of SCC on mivacurium-induced neuromuscular blockade and its reversal were investigated in 10 cats of either sex using the anterior tibialis muscle-sciatic nerve preparation. RESULTS: There was no significant difference at the onset of mivacurium neummuscular blockade between the control group(1.81+/-0.48 min) and SCC-pretreated group(1.86+/-1.04 min). However the duration of action of mivacurium neuromuscular blockade was significantly longer in the SCC-pretreated group(33.08+/-19.13 min) than that of the control group(10.65+/-2.45 min). In the control group recovery indices(RI) were 2.35+/-1.01 min and 0.68+/-0.30 min at spontaneous recovery and antagonism with neostigmine, respectively and in the SCC-pretreated group they were 6.88+/-2.42 min and 1.90+/-0.64 min. RI were significantly shortened by antagonism with neostigmine whether or not SCC was pretreated. In the SCC-pretreated group, RI were significantly longer than in the control group at spontaneous recovery and antagonism with neostigmine. But the maximal recovery and antagonism effect were 100% in all cases. There was no sigriificant difference in the train-of-four ratios measured after antagonism with neostigmine between the control group(0.91+/-0.01) and the SCC-pretreated group(0.93+/-0.06). CONCLUSIONS: The prior administration of SCC prolonged the duration of mivacurium-induced neuromuscular blockade and delayed recovery but had no influence in antagonism with neostigmine in cats.
Animals
;
Cats*
;
Drug Interactions
;
Neostigmine
;
Neuromuscular Blockade*
;
Respiratory Insufficiency
;
Succinylcholine*
9.The Effects of Atropine and Neostigmine on Heart Rate and Electrocardiogram in Anesthetized Patients .
Young Hee HWANG ; Ki Young AHN ; In Kyu KIM ; Yung Suk KIM ; Dong Ho PARK ; Wan Sik KIM
Korean Journal of Anesthesiology 1979;12(2):140-144
Four modes of administrating atropine and neostigmine to reverse pancuronium block were studied in thirty-eight anesthetized patients, with special reference to their effects on heart rate and electrocardiogram. At the end of operation in group 1 a mixture of atropine (0. 5 mg) and neostigmine(1. 0 mg) was rapidly injected together. In group 2 the same mixture was slowly injected in 3 minutes. In group 3 atropine was rapidly injected and 2 minutes later neostigmine was rapidly injected. In group 4 neostigmine was slowly injected in 1 minute and then immediately atropine was rapidly injected. The results were as follows. 1) In all groups a transient increase in heart rate was followed by a decrease which continued over 30 minutes. 2) The changes in heart rate were most pronounced when atropine was given before neostigmin(group 3) On the other hand when atropine was given immediately after neostigmine the changes in heart rate seemed to be smallest. 3) A small number of cases showed transient ECG changes in each group. It is considered that one must be careful about arterial gas and ECG changes although the number of cases is small and certain correlation was not indicated but the ECG of the five of 38 patients are abnormal, four of these are among the abnormal cases in the gas study, two of the four abnormals are under PaO2, 60 mmHg.
Atropine*
;
Electrocardiography*
;
Hand
;
Heart Rate*
;
Heart*
;
Humans
;
Neostigmine*
;
Pancuronium
10.The Priming Principle with Anticholinesterases for the Recovery of Profound Muscle Relaxation.
Kyo Sang KIM ; Jeong Uk HAN ; Yong Jin MIN ; Jeong Woo JEON ; Myoung Eui LEE ; Min Seon JEON ; Do Jun NA
Korean Journal of Anesthesiology 1994;27(12):1740-1746
The success of accelerating the onset of neuromvacular blocking drugs by giving them in divided doses encouraged others to attempt the same "priming principle" using reversal agents. Naguib et al and Abdulatif et al demonstrated that the reversal time(time to reach a TOF of 0.75) was reduced when the reversal agent was administered in divided doses at T, 10% of control. But Donati et al and Szalados et al either could not detect any differences in the rate of reversal when anticholinestereses were administered in divided doses. This study hes been conducted to evaluate the reversal effects of neostigmine or pyridostigmine with priming principle in the rabbit after pancuronium injection when pro- found relaxation(PTC=0) was confirmed. Rabbits(n=60) were randomly allocated to 4 groups. After pancuranium 0.2mg/kg IV, the onset and recovery times were evalusted. When the profound relaxation(PTC=0) was confirmed at Smin. after pancuronium injection, neostigmine 50 ug/kg and atropine sulfate (atropine) 20 ug/kg were injected in group 1. At thst time, neostigmine 10/kg and atropine 4 ug/kg were injected and after 3min. neostigmine 40/kg and atropine 16 ug/kg were injected in group 2. At that time, pyridostigmine 250 ug/kg and atropine 20 ug/kg were injected in group 3. At that time, pyridostigmine 50 ug/kg and atropine 4 ug/kg were injected and after 3min. pyridostigmine 200 ug/kg and atropine 16 ug/kg were injected in group 4. The results were as follows :. 1) The time until 75% recovery of twitch amplitude was 53.1+/-12.4min. in group 1, 44.9+/-212.1min. in group 2, 54.9+/-9.7min. in group 3 and 48.2+/-7.1min. in group 4. The reversal times were tended to reduce when the reversal agents were administered with "priming principle" at the profound relaxation. 2) At the profound relaxation the reversal effects of neostigmine were greater than that of pyridostigmine.
Atropine
;
Cholinesterase Inhibitors*
;
Muscle Relaxation*
;
Neostigmine
;
Pancuronium
;
Pyridostigmine Bromide
;
Relaxation