British Journal of Anaesthesia, Vol 76, Issue 2 239-244, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Abdulatif, A. Al-Ghamdi, M. Al-Sanabary and M. E. Abdel-Gaffar
We have studied the time course of recovery after administration of
edrophonium during intense mivacurium block in children aged 2-10 yr, using
thumb acceleration in response to train-of-four (TOF) stimulation.
Forty-three children receiving alfentanil, propofol, nitrous oxide,
isoflurane anaesthesia and mivacurium 0.2 mg kg-1 were allocated randomly
to one of three groups. Patients in group 1 (n = 15) received edrophonium 1
mg kg-1, 2 min after maximum block (intense block group). At the time of
administration of edrophonium in this group, there was no response to TOF
stimulation (100% block) and the post-tetanic count was 10.7 (range 0-20).
Patients in group 2 received the same dose of edrophonium after 10%
recovery of the first twitch (T1) in the TOF (conventional reversal).
Patients in group 3 (n = 13) recovered spontaneously. All patients
developed complete suppression of twitch height in response to the bolus
dose of mivacurium. All recovery times were measured from the point of
maximum block after mivacurium. Mean time for 25% recovery of T1 (clinical
duration) was 3.8 (SD 1.1) min in the intense block group. This was
significantly shorter than the conventional reversal (8.3 (2.4) min) and
spontaneous recovery (9.2 (3.5) min) groups (P < 0.001). The times for
75% and 90% recovery of T1 were shorter in the intense block group (9.4
(2.8), 12.3 (4.2) min) compared with the conventional (13.1 (3.8), 17.3
(4.8) min) and spontaneous recovery (14.9 (4.5), 17.9 (5.2) min) groups (P
< 0.01). Total recovery time required for 70% recovery of the TOF ratio
(T4/T1) was 8.8 (2.4) min in the intense block group. This was
significantly shorter than the conventional reversal (11.9 (3.2) min) (P
< 0.05) and spontaneous recovery (17.1 (4.0) min) groups (P < 0.001).
Conventional reversal was associated with a shorter total recovery time
compared with spontaneous recovery (P < 0.01). The recovery index (time
interval between T1 25% and 75%) was comparable in groups 1-3 (5.5 (2.0),
4.8 (2.1) and 5.7 (1.4) min respectively). Ten minutes after development of
maximum block, the numbers of patients who recovered adequately (TOF ratio
70% or more) were, respectively, 12 (80%), 8 (53%) and 1 (8%) in groups
1-3. We conclude that edrophonium antagonized intense (no response to TOF
stimulation) mivacurium-induced block in children, with significant
reduction in the recovery times of T1 and TOF ratio compared with
conventional reversal and spontaneous recovery.
CLINICAL INVESTIGATIONS
Edrophonium antagonism of intense mivacurium-induced neuromuscular block in children
Department of Anaesthesia, Cairo University, Egypt; King Faisal University, Saudi Arabia
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