British Journal of Anaesthesia, Vol 77, Issue 6 710-715, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Abdulatif, H. Mowafi, A. Al-Ghamdi and M. El-Sanabary
Dose-response relationships for the antagonism of intermediate-acting
neuromuscular blocking agents have not been evaluated previously in
children. We have examined the dose-response relationships for neostigmine
antagonism of 90% rocuronium-induced neuromuscular block in children and
adults, during nitrous oxide-1 MAC of isoflurane anaesthesia. We studied 40
children, aged 2-10 yr, and 50 adults, aged 18-60 yr; all received a single
bolus dose of rocuronium 0.6 mg kg-1 and accelerometry was used to monitor
neuromuscular transmission. When the first twitch of the train-of-four
(TOF) response (T1) recovered to 10% of its control (T0), one of five doses
of neostigmine 0, 5, 10, 20 or 50 micrograms kg-1 was given by random
allocation to each of the study groups (n = 8 children and n = 10 adults).
Recovery of T1 and TOF ratio (T4/T1%) was recorded for 10 min after initial
administration of neostigmine. Onset time of rocuronium-induced block was
faster in children than in adults (mean 64.6 (95% confidence intervals
57.7-71.5) s vs 83.7 (70.7-96.6) s; P < 0.05). The time to 10% recovery
of T1/T0 was shorter in children than in adults (25.4 (22.9-27.9) min vs
38.8 (36.1-41.4) min; P < 0.001). Spontaneous and antagonist-assisted
recovery were more rapid in children than in adults. Adequate recovery
(T4/T1 of 80%) occurred in children at 4, 5 and 8 min after neostigmine 50,
20 and 10 micrograms kg-1, respectively. Adequate recovery was not produced
in adults by any dose of neostigmine within 10 min. The effective doses of
neostigmine required to achieve a TOF ratio of 80% (ED80) after 10 min in
children and adults were, respectively, 7.10 (5.2-9.8) micrograms kg-1 and
56.56 (45.5-71.9) micrograms kg-1 (P < 0.001). There was no advantage in
administering doses of neostigmine greater than 20 micrograms kg-1 to
antagonize 90% rocuronium-induced neuromuscular block in children. In
contrast, it appeared prudent to use neostigmine 50 micrograms kg-1 or more
for adequate antagonism of a similar degree of block in adults.
CLINICAL INVESTIGATIONS
Dose-response relationships for neostigmine antagonism of rocuronium-induced neuromuscular block in children and adults
Department of Anaesthesia, Cairo University, Egypt; Department of Anaesthesia, King Faisal University, Saudi Arabia
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