ANTAGONISM OF PROFOUND NEUROMUSCULAR BLOCKADE INDUCED BY VECURONIUM * OR ATRACURIUM

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Abstract
The effectiveness of neostigmine 0.07mg kg−1 and edrophonium 0.8 mg kg−1 as antagonists of profound neuromuscular blockade induced by vecuronium 0.1 mg kg−1 or atracurium 0.5 mg kg−1 was studied in 59 healthy patients. The antagonists were administered 5 min after total ablation of the twitch response and the end-point of recovery was a train-of-four ratio of 70%. In 30 patients given vecuronium the mean time to reach this point (duration TOF70) was 66.7min in the control group (no antagonist), 43.5 min in the group given neostigmine and 59.8 min in the group given edrophonium. The duration TOF70 was shorter in the neostigmine group than in the control {P < 0.01) and edrophonium (P70 did not differ from control in the edrophonium group. In 29 patients given atracurium, the durations TOF70 were 66.4, 44.1 and 54.9 min in the control, neostigmine and edrophonium groups, respectively. The durations TOF70 in the neostigmine (P < 0.01) and edrophonium (P < 0.01), groups were shorter than control. The duration TOF70 of the neostigmine group was shorter than in the edrophonium group (P < 0.01). These results show that pro-found neuromuscular blockade cannot be rapidly antagonized by either of these two agents, but if reversal is required under these circumstances, neostigmine would be the more effective drug.