British Journal of Anaesthesia, Vol 77, Issue 4 492-495, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
N. W. Fleming, S. Macres, J. F. Antognini and J. Vengco
The reported effects of edrophonium on a subsequent dose of suxamethonium
are variable and the effects of pyridostigmine have not been evaluated
extensively. We have studied this interaction in patients anaesthetized
with propofol and sufentanil. After recovery from an initial bolus (1 mg
kg-1) of suxamethonium, vecuronium was infused to produce 75% block. After
30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg
kg-1, pyridostigmine 0.24 mg kg-1 or neostigmine 0.05 mg kg-1 was given.
Fifteen minutes later the mean durations of a second bolus of suxamethonium
were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4)
min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma
cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9),
21 (10) and 52 (26). When both treatment groups and individual patients
were compared, the changes in duration of action did not correlate with
changes in cholinesterase activity. These data suggest that other
mechanisms in addition to cholinesterase inhibition may contribute to this
drug interaction.
CLINICAL INVESTIGATIONS
Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine
Department of Anesthesiology, University of California, Davis, CA, USA
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