Neuromuscular Effects of d-Tubocurarine, Edrophonium and Neostigmine in Man

Abstract

The neuromuscular effects of d-tubocurarine, edrophonium and neostigmine were determined in patients anesthetized with nitrous oxide plus trichlorethylene, meperedine, or thiamylal. The effect of d-tubocurarine (0.1 mg/kg) was variable, ranging from no effect on twitch tension to abolition of the twitch response. Because of this variation in response the routine use of a fixed mg/kg dose of d-tubocurarine was not recommended. Edrophonium (10-100 mg) was found to be unsatisfactory as an antagonist of tubocurarine. Neostigmine (2.5-5 mg), however, was found to be a good antagonist of d-tubocurarine. Although there is still some controversy concerning the mechanism of anticurare action of edrophonium and neostigmine, cholinesterase inhibition appears to be a major factor.