Conclusions
Whenever NMBD’s have been used during anaes-thesia attempts should be made to antagonize them if any TOF fade is visible. Reversal may be attempted with an anticholinesterase, either neostigmine 2.5mg·70kg-1 or edrophonium 35 mg · 70 kg-1 mixed with either glycopyrrolate or atropine. The dose may be repeated ten minutes later if recovery of respiration or neuromuscular activity is not complete. However, the choice of antagonists is less important than recognizing indications for their use.
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References
Waud BE,Waud DR. The relation between tetanic fade and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology 1971; 35:456–64.
Katz RL. Clinical neuromuscular pharmacology of pancuronium. Anesthesiology 1971; 34:550–6.
Johansen SH, Jorgensen M, Molbech S. Effect of tubocurarine on respiratory and non respiratory muscle power in man. J Appl Physiol 1964; 19:990–4.
Miller RD. Antagonism of neuromuscular blockade. Anesthesiology 1976; 44:318–29.
Gal TJ, Goldberg SK. Relationship between respiratory muscle strength and vital capacity during partial curarisation in awake subjects. Anesthesiology 1981; 54:141–7.
Ali HH, Utting JE, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. Br J Anaesth 1970; 42:967–78.
Lee C, Katz RL, Fade of neurally evoked compound electromyogram during neuromuscular block by d-tubocurarine. Anesth Analg 1977; 56:271–5.
Ali HH, Savarese JJ, Lebowitz PW, Ramsay FM. Twitch, tetanus and train-of-four as indices of recovery from non-depolarizing neuromuscular blockade. Anesthesiology 1981; 54:294–7.
Bowman WC. Prejuncdonal and postjunctional cholinoceptors at the neuromuscular junction. Anesth Analg 1980; 59:935–433.
Stanec A, Stanec G. The adductor pollicis monitor – apparatus and method for the quantitative measurement of the isometric contraction of the adductor pollicis muscle. Anesth Analg 1983; 62:602–5.
Epstein RA, Epstein RM. Electromyography in evaluation of the response to muscle relaxants. In: Muscle Relaxants (ed. Katz RL), Excerpta Medica, New York, 299–312 (1975).
Lam HS, Morgan DL, Lampard DG. Derivation of reliable electromyograms and their relation to tension in mammalian skeletal muscles during synchronous stimulation. Electroenceph Clin Neurophys 1979; 46:72–80.
Viby-Morgensen J. Clinical assessment of neuro-muscular transmission. Br J Anaesth 1982; 54:209–23.
Waud BE, Waud DR. The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 1972; 37:417–22.
Cullen SC. The use of curare for the improvement of abdominal muscle relaxation during inhalation anaesthesia. Surgery 1943; 14:261–6.
Rees GJ. Paediatric anaesthesia. Br J Anaesth 1960; 32:132–40.
Kelly, SS, Roberts DV. The effect of age on the safety factor in neuromuscular transmission in the isolated diaphragm of the rat. BrJ Anaesth 1977; 49:217–22.
Keens TG, Bryan AC, Levison H, lanuzzo CD. Developmental pattern of muscle fiber types in human ventilatory muscles. J Appl Physiol 1978;44:909–13.
Goudsouzian NG, Crone RK, Todres ID. Recovery from pancuronium blockade in the neonate intensive care unit. Br J Anaesth 1981; 53:1303–9.
Crumrine RS, Yodlowski EH. Assessment of neuromuscular function in infants. Anesthesiology 1981; 54:29–32.
Nightingale DA, Glass AG, Bachman L. Neuromuscular blockade by succinylcholine in children. Anesthesiology 1966; 27:736–41.
Walts LF, Dillon JB. The response of newboms to succinylcholine and d-tubocurarine. Anesthesiology 1969; 31:35–8.
Cook DR, Fischer CG. Neuromuscular blocking effects of succinylcholine in infants and children. Anesthesiology 1975; 42:662–5.
Walts LF, Dillon JB. Clinical studies on succinylcholine chloride. Anesthesiology 1967; 38:372–66.
Katz RL, Ryan JF. The neuromuscular effects of suxamethonium in man. Br J Anaesth 1969; 41:381–900.
Cook DR, Fischer CG. Characteristics of succinylcholine neuromuscular blockade in neonates. Anesth Analg 1978; 57:63–6.
Sutherland GA, Bevan JC, Bevan DR. Neuromuscular blockade in infants following intramuscular succinylcholine in two or five percent concentration. Can Anaesth Soc J 1983; 30:342–6.
Liu LMP, De Cook TH, Goudsouzian NG, Ryan JF, Liu PL. Dose response to intramuscular succinylcholine in children. Anesthesiology 1981; 55:599–602.
Zsigmond EK, Downs JR. Plasma cholinesterase activity in newborns and infants. Can Anaesth Soc J 1971; 18:278–85.
Cook DR, Westman HR, Rosenfeld L, Hendershot RJ. Pulmonary edema in infants: possible association with intramuscular succinylcholine. Anesth Analg 1981; 60:220–3.
De Cook TH, Goudsouzian NG. Tachyphylaxis and phase 1l block development during infusion of succinylcholine in children. Anesth Analg 1980; 59:639–43.
Goudsouzian NG, Liu LMP. The development of tachyphylaxis and phase II block during the infusion of succinylcholine in infants. Anesthesiology 1983; 57:A284.
Basta SJ, Ali HH, Savarese JJ, et al. Clinical pharmacology of atracurium besylate (BW 33A): a new non-depolarizing muscle relaxant. Anesth Analg 1982; 61:723–9.
Goudsouzian NG, Liu LPM, Cote CJ, Gionfriddo M, Rudd GD. Safety and efficacy of atracurium in adolescents and children anesthetized with halothane. Anesthesiology 1983; 59:459–62.
Goudsouzian NG, Liu LMP, Gionfriddo M, Otcasek D. The dose response effect of atracurium in infants. Anesth Analg 1984; 63:223.
Fahey MR, Morris RB, Miller RD, Sohn YJ, Cronnelly R, Gencarelli P. Clinical pharmacology of ORG NC45 (Norcuron). A new nondepolarizing muscle relaxant. Anesthesiology 1981; 55:6–11.
Fisher DM, Miller RD. Neuromuscular effects of vecuronium (ORG NC45) in infants and children during N2O, halothane anesthesia. Anesthesiology 1983; 58:519–23.
Goudsouzian NG, Ryan JF, Savarese JJ. The neuromuscular effects of pancuronium in infants and children. Anesthesiology 1974; 41:95–8.
Donlon JV, Ali HH, Savarese JJ. A new approach to the study of four non-depolarizing relaxants in man. Anesth Analg 1974; 53:934–8.
Goudsouzian NG, Donlon JV, Savarese JJ, Ryan JF. Reevaluation of dosage and duration of action of d-tubocurarine in the pediatric age group. Anesthesiology 1975; 43:416–25.
Goudsouzian NG, Liu LMP , Savarese JJ. Meto-curine in infants and children. Anesthesiology 1978; 49:266–9.
Goudsouzian NG, Liu LMP, Cole CJ. Comparison of equipotent doses of non-depolarizing muscle relaxants in children. Anesth Analg 1981; 60:862–6.
Savarese JJ, Ali HH, Antonio RP. The clinical pharmacology of metocurine. Anesthesiology 1977; 47:277–84.
Fisher DM, O’Keeffe C, Stanski DR, Cronnelly R, Miller RD, Gregory GA, Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children and adults. Anesthesiology 1982; 57:203–8.
Churchiil’Davidson HC. The d-tubocurarine dilemma. Anesthesiology 1965; 26:132–3.
Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four response and respiratory measurements in humans. Br J Anaesth 1975; 47:570–4.
Bevan DR. Reversal of pancuronium with edrophonium. Anaesthesia 1979; 34:614–9.
Kopman AF. Edrophonium antagonism of pancuronium-induced neuromuscular blockade in man: a reappraisal. Anesthesiology 1979; 51:139–42.
Ferguson A, Egerszegi P, Bevan DR. Neostigmine, pyridostigmine, and edrophonium as antagonists of pancuronium. Anesthesiology 1980; 53:390–4.
Cronnelly R, Morris RB, Miller RD. Edrophonium: duration of action and atropine requirement in humans during halothane anesthesia. Anesthesiology 1982; 57:261–6.
Morris RB, Cronnelly R, Miller RD, Stanski DR, Fahey MR. Pharmacokinetics of edrophonium and neostigmine when antagonizing d-tubocurarine neuromuscular blockade in man. Anesthesiology 1981; 54:399–402.
Randall LO, Conroy CE, Ferruggia TM, Kappell BYH, Knoepel CR. Pharmacology of the anticholinesterase drugs – mestinon, prostigmin, tensilon and TEPP. Amer J Mcd 1955; 19:673–8.
Miller RD, Cronnelly R. A new look at an old drug. Anesthesiology, 1983; 59:84–5.
Sugai N, Payne JP. The skeletal muscle response to edrophonium during neuromuscular blockade by tubocurarine in anaesthetized man. Br J Anaesth 1975; 47:1087–92.
Payne JP, Hughes R, Al Azawi S. Neuromuscular blockade by neostigmine in anaesthetized man. Br J Anaesth 1980; 52:69–76.
Azar l, Pham AN, Karambelkar DJ, Lear E. The heart rate following edrophonium-atropine and edrophonium-glycopyrollate mixtures. Anesthesiology 1983; 59:139–41.
Lee C, Katz RL. Neuromuscular pharmacology: a clinical update and commentary. Br J Anaesth 1980; 52:173–88.
Miller RD, Roderick LL. Acid-base balance and neostigmine antagonism of pancuronium neuromuscular blockade. Br J Anaesth 1978; 50:317–24.
Bevan DR, Archer D, Donati F, Ferguson A, Higgs BD. Reversal of pancuronium in renal failure. Br J Anaesth 1982; 54:63–8.
Cronnelly R Stanski DR, Miller RD, Sheiner LB, Sohn YJ. Renal function and the pharmacokinetics of neostigmine in anaesthetized man, Anesthesiology 1979; 515:222–6.
Fisher DM, Cronnelly R, Miller RD, Sharma M. The neuromuscular pharmacology of neostigmine in infants and children. Anesthesiology 1983; 59:220–5.
Meakin G, Sweet PT, Bevan JC, Bevan DR. Neostigmine and edrophonium as antagonists of pancuronium in infants and children. Anesthesiology 1983; 59:316–21.
Futter ME, Donati F, Bevan DR, Neostigmine antagonism of succinylcholine phase II block: a comparison with pancuronium. Can Anaesth Soc J 1983; 30:575–80.
Bevan DR, Donati F. Succinylcholine apnoea: attempted reversal of anticholinesterases. Can Anaesth Soc J 1983; 30:536–9.
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Donati, F., Bevan, J.C. & Bevan, D.R. Neuromuscular blocking drugs in anaesthesia. Can Anaesth Soc J 31, 324–335 (1984). https://doi.org/10.1007/BF03007899
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DOI: https://doi.org/10.1007/BF03007899