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Antagonism of non‐depolarising neuromuscular block: current practice
Author(s) -
Kopman A. F.,
Eikermann M.
Publication year - 2009
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.1365-2044.2008.05867.x
Subject(s) - medicine , neostigmine , neuromuscular monitoring , anesthesia , neuromuscular transmission , antagonism , block (permutation group theory) , neuromuscular disease , neuromuscular blockade , receptor , geometry , mathematics , disease
Summary There is now mounting evidence that even small degrees of postoperative residual neuromuscular block increases the incidence of adverse respiratory events in the Post Anaesthesia Care Unit and may increase longer‐term morbidity as well. In the absence of quantitative neuromuscular monitoring, residual block is easily missed. A very strong case can be made for the routine administration of a non‐depolarising antagonist unless it can be objectively demonstrated that complete recovery has occurred spontaneously. However, the use of acetylcholinesterase inhibitors is associated with the potential for cardiovascular and respiratory side‐effects, so there are cogent reasons for using low doses when the level of neuromuscular block is not intense. As little as 0.015–0.025 mg.kg −1 of neostigmine is required at a train‐of‐four count of four with minimal fade, whereas 0.04–0.05 mg.kg −1 is needed at a train‐of‐four count of two or three. If only a single twitch or none at all can be evoked, neostigmine should not be expected to promptly reverse neuromuscular block, and antagonism is best delayed till a train‐of‐four‐count of two is achieved.