Antagonism of vecuronium-induced neuromuscular block in patients pretreated with magnesium sulphate: dose-effect relationship of neostigmine

We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmin...

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Bibliographic Details
Published in:	British journal of anaesthesia : BJA Vol. 82; no. 1; pp. 61 - 65
Main Authors:	Fuchs-Buder, T, Ziegenfuss, T, Lysakowski, K, Tassonyi, E
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier Ltd 01-01-1999 Oxford University Press Oxford Publishing Limited (England)
Subjects:	Adult Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Arrhythmia Agents - pharmacology Anticonvulsants - pharmacology Biological and medical sciences Bradycardia - chemically induced Cholinesterase Inhibitors - pharmacology Dose-Response Relationship, Drug Double-Blind Method Drug Interactions Electromyography Female General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Humans Magnesium Sulfate - pharmacology Male Medical sciences Middle Aged Neostigmine - pharmacology Neuromuscular Blockade Neuromuscular Junction - drug effects Neuromuscular Junction - physiology Neuromuscular Nondepolarizing Agents - antagonists & inhibitors Prospective Studies Vecuronium Bromide - antagonists & inhibitors Human Steroid Magnesium sulfate Enzyme Neostigmine bromide Enzyme inhibitor General anesthesia Esterases Vecuronium bromide Cholinesterase Carboxylic ester hydrolases Dose activity relation Reversion Non depolarisant myorelaxant Hydrolases Antagonist Anticholinesterase agent Neuromuscular blocking
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Summary:	We have investigated the dose-effect relationship of neostigmine in antagonizing vecuronium-induced neuromuscular block with and without magnesium sulphate (MgSO4) pretreatment. Neuromuscular block was assessed by electromyography with train-of-four (TOF) stimulation. First, we determined neostigmine-induced recovery in patients pretreated with MgSO4 (group A) or saline (group B) (n = 12 each). The height of T1, 5 min after neostigmine, was 43 (7)% in group A and 65 (6)% in group B (P < 0.01). Respective values after 10 min were 59 (7)% and 83 (5)% (P < 0.01). TOF ratio, 5 min after neostigmine, was 29 (6)% in group A and 29 (5)% in group B. Respective values after 10 min were 38 (11)% and 51 (7)% (P < 0.01). To gain insight into the mechanisms leading to delayed recovery after MgSO4, we calculated assisted recovery, defined as neostigmine-induced recovery minus mean spontaneous recovery. Spontaneous recovery was assessed in another 24 patients. Patients in group C received MgSO4/vecuronium and patients in group D vecuronium only (n = 12 each). Five minutes after neostigmine, assisted recovery was 22 (7)% in the MgSO4 pretreated patients and 28 (6)% in controls (P < 0.05). Ten minutes after neostigmine, values were 24 (7)% and 22 (6)%. Maximum assisted recovery was not influenced by MgSO4 pretreatment (27 (6)% in group A and 32 (6)% in group B) and time to maximum effect was comparable between groups: 6 (4-10) min and 7 (5-8) min, respectively. We conclude that neostigmine-induced recovery was attenuated in patients treated with MgSO4. This was mainly a result of slower spontaneous recovery and not decreased response to neostigmine.
ISSN:	0007-0912 1471-6771
DOI:	10.1093/bja/82.1.61