Edrophonium antagonism of cisatracurium-induced neuromuscular block : Dose requirements in children and adults

• Published in: Anaesthesia and intensive care Vol. 29; no. 4; pp. 364 - 370
• Main Authors: ABDULATIF, M, EL-SANABARY, M
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01-08-2001
• Subjects: Adult; Anesthetics. Neuromuscular blocking agents; Atracurium - analogs & derivatives; Atracurium - antagonists & inhibitors; Biological and medical sciences; Child; Child, Preschool; Cholinesterase Inhibitors - administration & dosage; Dose-Response Relationship, Drug; Edrophonium - administration & dosage; Electric Stimulation; Humans; Medical sciences; Middle Aged; Neuromuscular Blockade; Neuromuscular Blocking Agents - antagonists & inhibitors; Neuropharmacology; Pharmacology. Drug treatments; Ulnar Nerve - physiology; Cisatracurium besilate; Esterases; Dose activity relation; Alkaloid; Reversion; Edrophonium chloride; Adult; Antagonist; Child; Age; Neuromuscular blocking; Monitoring; Halogen Organic compounds; Human; Volatile compound; Isoquinoline derivatives; Enzyme; Enzyme inhibitor; General anesthesia; Neuromuscular transmission; Cholinesterase; Isoflurane; Carboxylic ester hydrolases; Gases; Non depolarisant myorelaxant; General anesthetic; Hydrolases; Nitrogen protoxide
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057x0102900406

This randomized, controlled study compared edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N2O anaesthesia, were studied. Cisatracurium 0.1 mg x kg(-1) was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg x kg(-1) or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n=12). Atropine 5 to 10 microg x kg(-1) was given according to edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P<0.01. The times to 10% spontaneous recovery of the first twitch (T1) were respectively, 28.4 (5.2) and 41.8 (6.1) minutes in children and adults, P<0.01. Spontaneous and antagonist assisted neuromuscular recovery was more rapid in children. Adequate neuromuscular recovery (train of four (TOF) ratio 80%) was achieved in children at 3 and 10 minutes after edrophonium 1.0 mg kg(-1) and 0.4 mg x kg(-1), respectively. A TOF ratio of 80% was not achieved, within 10 minutes, with any of the four dose levels of edrophonium in adults. The dose of edrophonium to achieve a TOF ratio of 80% (ED(TOF-80)) after 5 and 10 minutes in children were, respectively, mean (SD) 0.85 (0.38) and 0.38 (0.19) mg x kg(-1). The equivalent ED(TOF-80) in adults was outside the edrophonium dose range studied.