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British Journal of Anaesthesia, 1980, Vol. 52, No. 1 69-76
© 1980 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

NEUROMUSCULAR BLOCKADE BY NEOSTIGMINE IN ANAESTHETIZED MAN

J. P. PAYNE, M.B., F.F.A.R.C.S., D.A., R. HUGHES, B.SC., M.SC., PH.D.* and S. AL AZAWI, M.B., CH.B., F.F.A.R.C.S.I.

Research Department of Anaesthetics, Royal College of Surgeons of England London WC2 and St Peter's Hospitals London WC2

The tetanic and single twitch responses of the adductor pollicis muscle were used to study the neuromuscular effects of neostigmine in 26 patients anaesthetized with thiopentone and nitrous oxide. Neostigmine 2.5 mg i.v. given 5 min after exposure to halothane antagonized non-depolarizing neuromuscular block, whereas a second dose given 2–5 min later depressed the peak tetanic contraction and re-established tetanic fade. In the absence of halothane the second dose of neostigmine had less effect. Recovery of the single twitch was not impaired by the second dose. A single dose of neostigmine 5 mg rapidly antagonized the competitive block of the tetanic response but the subsequent slight depression of the peak contraction and the brief reappearance of fade were less than after 5 mg given in two doses of 2.5 mg. In patients who were not given neuromuscular blocking drugs, one or two injections of neostigmine 2.5 mg caused a substantial reduction in the peak tetanic contraction and severe tetanic fade which persisted for about 20 min; the single twitch was slightly potentiated. The neostigmine block of the tetanic response could be antagonized by galla-mine and potentiated by suxamethonium. These findings indicate that neostigmine in clinical doses can produce an acetylcholine-induced block which would be a potential hazard in anaesthetic practice.

* Present address: Pharmacology Department, The Wellcome Research Laboratories, Langley Court, Beckenham, Kent.


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