Neostigmine and Edrophonium as Antagonists of Pancuronium in Infants and Children

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Abstract
The rates of recovery of neuromuscular activity following reversal of pancuronium-inudced neuromuscular blockade with neostigmine or edrophonium were studied in 3 groups of 24 pediatric patients: babies 0-3 mo., infants 3-12 mo. and children 1-10 yr. Reversal was attempted at 10% spontaneous recovery of muscle twitch with neostigmine, 0.036 or 0.071 mg/kg, or edrophonium 0.71 or 1.43 mg/kg. Rapid, sustained recovery of function followed administration of either antagonist. Recovery was more rapid after edrophonium than neostigmine, was similar in all 3 age groups, but was significantly more rapid than reported previously in adults. Two min after neostigmine, the mean recovery of first twitch tension in pediatric patients was 58.6 .+-. 4.9% after 0.036 mg/kg and 70.6 .+-. 4.3% after 0.071 mg/kg, compared with 84.8 .+-. 3.2% and 92.6 .+-. 2% after edrophonium 0.71 and 1.43 mg/kg, respectively. In adults, recovery 2 min after similar doses of antagonist was 29.5 .+-. 4.9% and 55.7 .+-. 6.6% after neostigmine and 62.0 .+-. 3.5% and 71.2 .+-. 2.3% after edrophonium. When the extent of recovery of first twitch tension was compared with recovery of train-of-four ratio was greater with edrophonium than neostigmine for the same tension and was greater in babies and infants than in children and adults after the same antagonist. Reversal of pancuronium can evidently be achieved more rapidly in pediatric patients than adults, is more rapid after edrophonium than neostigmine, and qualitative differences in the pattern of recovery are seen in subjects less than 1 yr old.