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Atracurium recovery: prediction of safe reversal times with edrophonium
Author(s) -
CASHMAN J. N.,
JONES R. M.,
ADAMS A. P.
Publication year - 1989
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1989.tb09095.x
Subject(s) - edrophonium , medicine , anesthesia , neuromuscular monitoring , halothane , muscle relaxant , atracurium besilate , neuromuscular blockade , neostigmine
Summary The time to safe return of neuromuscular function after atracurium 0.3 mg/kg intravenously was assessed in 24 patients in whom anaesthesia was maintained with halothane 0.5%. Safe reversal (recovery to a T4 ratio > 05), after this dose of atracurium, could only be reliably and rapidly (< 2 minutes) achieved with edrophonium if a period greater than 30 minutes elapsed since administration of the relaxant. This coincides with the appearance of four recognisable twitches if a train‐of‐four pattern of nerve stimulation is used. Thus, if no monitoring equipment is available, at least half‐an‐hour should elapse after administration of atracurium in a moderate dose (e.g. 0.3 mg/kg) before rapid and reliable reversal can be anticipated. Four twitches in a train‐of‐four should be recognisable, if a nerve stimulator is available.