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Dose-response relationships for neostigmine antagonism of rocuronium-induced neuromuscular block in children and adults.
Br J Anaesth. 1996 Dec; 77(6):710-5.BJ

Abstract

Dose-response relationships for the antagonism of intermediate-acting neuromuscular blocking agents have not been evaluated previously in children. We have examined the dose-response relationships for neostigmine antagonism of 90% rocuronium-induced neuromuscular block in children and adults, during nitrous oxide-1 MAC of isoflurane anaesthesia. We studied 40 children, aged 2-10 yr, and 50 adults, aged 18-60 yr; all received a single bolus dose of rocuronium 0.6 mg kg-1 and accelerometry was used to monitor neuromuscular transmission. When the first twitch of the train-of-four (TOF) response (T1) recovered to 10% of its control (T0), one of five doses of neostigmine 0, 5, 10, 20 or 50 micrograms kg-1 was given by random allocation to each of the study groups (n = 8 children and n = 10 adults). Recovery of T1 and TOF ratio (T4/T1%) was recorded for 10 min after initial administration of neostigmine. Onset time of rocuronium-induced block was faster in children than in adults (mean 64.6 (95% confidence intervals 57.7-71.5) s vs 83.7 (70.7-96.6) s; P < 0.05). The time to 10% recovery of T1/T0 was shorter in children than in adults (25.4 (22.9-27.9) min vs 38.8 (36.1-41.4) min; P < 0.001). Spontaneous and antagonist-assisted recovery were more rapid in children than in adults. Adequate recovery (T4/T1 of 80%) occurred in children at 4, 5 and 8 min after neostigmine 50, 20 and 10 micrograms kg-1, respectively. Adequate recovery was not produced in adults by any dose of neostigmine within 10 min. The effective doses of neostigmine required to achieve a TOF ratio of 80% (ED80) after 10 min in children and adults were, respectively, 7.10 (5.2-9.8) micrograms kg-1 and 56.56 (45.5-71.9) micrograms kg-1 (P < 0.001). There was no advantage in administering doses of neostigmine greater than 20 micrograms kg-1 to antagonize 90% rocuronium-induced neuromuscular block in children. In contrast, it appeared prudent to use neostigmine 50 micrograms kg-1 or more for adequate antagonism of a similar degree of block in adults.

Authors+Show Affiliations

Department of Anaesthesia, Cairo University, Egypt.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9014620

Citation

Abdulatif, M, et al. "Dose-response Relationships for Neostigmine Antagonism of Rocuronium-induced Neuromuscular Block in Children and Adults." British Journal of Anaesthesia, vol. 77, no. 6, 1996, pp. 710-5.
Abdulatif M, Mowafi H, al-Ghamdi A, et al. Dose-response relationships for neostigmine antagonism of rocuronium-induced neuromuscular block in children and adults. Br J Anaesth. 1996;77(6):710-5.
Abdulatif, M., Mowafi, H., al-Ghamdi, A., & el-Sanabary, M. (1996). Dose-response relationships for neostigmine antagonism of rocuronium-induced neuromuscular block in children and adults. British Journal of Anaesthesia, 77(6), 710-5.
Abdulatif M, et al. Dose-response Relationships for Neostigmine Antagonism of Rocuronium-induced Neuromuscular Block in Children and Adults. Br J Anaesth. 1996;77(6):710-5. PubMed PMID: 9014620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-response relationships for neostigmine antagonism of rocuronium-induced neuromuscular block in children and adults. AU - Abdulatif,M, AU - Mowafi,H, AU - al-Ghamdi,A, AU - el-Sanabary,M, PY - 1996/12/1/pubmed PY - 1996/12/1/medline PY - 1996/12/1/entrez SP - 710 EP - 5 JF - British journal of anaesthesia JO - Br J Anaesth VL - 77 IS - 6 N2 - Dose-response relationships for the antagonism of intermediate-acting neuromuscular blocking agents have not been evaluated previously in children. We have examined the dose-response relationships for neostigmine antagonism of 90% rocuronium-induced neuromuscular block in children and adults, during nitrous oxide-1 MAC of isoflurane anaesthesia. We studied 40 children, aged 2-10 yr, and 50 adults, aged 18-60 yr; all received a single bolus dose of rocuronium 0.6 mg kg-1 and accelerometry was used to monitor neuromuscular transmission. When the first twitch of the train-of-four (TOF) response (T1) recovered to 10% of its control (T0), one of five doses of neostigmine 0, 5, 10, 20 or 50 micrograms kg-1 was given by random allocation to each of the study groups (n = 8 children and n = 10 adults). Recovery of T1 and TOF ratio (T4/T1%) was recorded for 10 min after initial administration of neostigmine. Onset time of rocuronium-induced block was faster in children than in adults (mean 64.6 (95% confidence intervals 57.7-71.5) s vs 83.7 (70.7-96.6) s; P < 0.05). The time to 10% recovery of T1/T0 was shorter in children than in adults (25.4 (22.9-27.9) min vs 38.8 (36.1-41.4) min; P < 0.001). Spontaneous and antagonist-assisted recovery were more rapid in children than in adults. Adequate recovery (T4/T1 of 80%) occurred in children at 4, 5 and 8 min after neostigmine 50, 20 and 10 micrograms kg-1, respectively. Adequate recovery was not produced in adults by any dose of neostigmine within 10 min. The effective doses of neostigmine required to achieve a TOF ratio of 80% (ED80) after 10 min in children and adults were, respectively, 7.10 (5.2-9.8) micrograms kg-1 and 56.56 (45.5-71.9) micrograms kg-1 (P < 0.001). There was no advantage in administering doses of neostigmine greater than 20 micrograms kg-1 to antagonize 90% rocuronium-induced neuromuscular block in children. In contrast, it appeared prudent to use neostigmine 50 micrograms kg-1 or more for adequate antagonism of a similar degree of block in adults. SN - 0007-0912 UR - https://www.unboundmedicine.com/medline/citation/9014620/Dose_response_relationships_for_neostigmine_antagonism_of_rocuronium_induced_neuromuscular_block_in_children_and_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)42030-7 DB - PRIME DP - Unbound Medicine ER -