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Factors affecting neostigmine reversal of vecuronium block during sevoflurane anaesthesia
Author(s) -
Morita T.,
Kurosaki D.,
Tsukagoshi H.,
Shimada H.,
Sato H.,
Goto F.
Publication year - 1997
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.1365-2222.1997.119-az0123.x
Subject(s) - neostigmine , medicine , sevoflurane , adductor pollicis muscle , anesthesia , neuromuscular transmission , neuromuscular monitoring , block (permutation group theory) , motor block , ulnar nerve , neuromuscular blockade , surgery , bupivacaine , geometry , mathematics , elbow
We examined the influence of the concentration of sevoflurane and the degree of muscle block at the time of reversal on the activity of neostigmine. Ninety ASA 1–2 patients were anaesthetised with 0.2, 0.7 or 1.2 MAC of sevoflurane (30 patients each) in 66% nitrous oxide in oxygen. The electromyographic (EMG) response of the adductor digiti minimi was monitored at 20‐s intervals after train‐of‐four stimulation of the ulnar nerve. The initial neuromuscular block was produced by vecuronium 100 μg.kg −1 . When the amplitude of the first response (T1) values had recovered to 10%, 25% or 40% of the control, neostigmine 40 μg.kg −1 was administered. The train‐of‐four ratio values were recorded at 1‐min intervals during the subsequent 15‐min period. Higher end‐tidal concentrations (p < 0.0001) and more pronounced block at the time of reversal (p < 0.0001) were associated with a delayed recovery in the train‐of‐four ratio. In addition, the train‐of‐four ratio 15 min after neostigmine administration was more dependent on the sevoflurane concentration than on the degree of block present (p < 0.0001). These results confirm that neostigmine (40 μg.kg −1 ) can reverse vecuronium‐induced but not sevoflurane‐induced neuromuscular block.