Dose-Response Relations of Doxacuriurn and Its Reversal With Neostigmine in Young Adults and Healthy Elderly Patients

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Abstract
Dose-response relationships for doxacurium and neostigmine were established in 24 young (18–40 yr) and 24 elderly (70–85 yr) patients, ASA physical status I or II, anesthetized with thiopental, fentanyl, nitrous oxide, and isoflurane. Mechanomyographic response of the adductor pollicis muscle to the train-of-four stimulation of the ulnar nerve was recorded. Doxacurium (5, 10, 15, or 20 μg/kg IV) was administered by random allocation. After maximal blockade, an additional dose, for a total of 30 μg/kg, was administered. When first twitch height recovered to 25%, incremental doses of 5 μg/kg were administered for maintenance of relaxation. Neostigmine (5, 10, 20, or 40 μg/kg) was injected at 25% first twitch recovery, and neuromuscular monitoring was continued for 10 min. The doses of doxacurium (±SEM) required to produce a 50%, 90%, and 95% depression of twitch tension in the young patients were, respectively, 13.3 ± 1.6, 23.6 ± 2.8, and 28.6 ± 3.4 μg/kg, not statistically different from corresponding values in the elderly, 11.8 ± 1.3, 21.2 ± 2.3, and 25.9 ± 2.9 μg/kg, respectively. Time to 25% recovery after 30 μg/kg was 80.2 ± 12.2 min in the young versus 133.0 ± 17.1 min in the elderly (P

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