Comparison of Physostigmine and Neostigmine for Antagonism of Neuromuscular Block
- 1 October 1981
- journal article
- research article
- Published by Wiley in Acta Anaesthesiologica Scandinavica
- Vol. 25 (5), 387-390
- https://doi.org/10.1111/j.1399-6576.1981.tb01671.x
Abstract
The ability of physostigmine alone and in combination with neostigmine to reverse d-tubocurarine-induced neuromuscular block was evaluated in surgical patients. The relaxation was maintained at a level of 90% twitch suppression during balanced anesthesia, and antagonism was attempted with physostigmine 1.5 mg .times. 3; neostigmine 0.5 mg .times. 3; neostigmine 1.0 mg .times. 3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg .times. 3. The measured parameters included the twitch force or EMG [electromyogram] amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 Hz stimulation and fading of these responses after repetitive 2 and 50 Hz stimuli. Although the restitution rate of twitch height and EMG amplitude were essentially the same with both antagonists, there was a considerable time-lag in regeneration of the fades after repetitive stimuli with physostigmine as compared with the neostigmine group. The addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. The clinical antagonism was satisfactory in all patients receiving physostigmine. The divergence of relaxation-indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of the 2 antagonists at the neuromuscular junction.This publication has 16 references indexed in Scilit:
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