Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine

Neal Fleming, Stephen M Macres, J. F. Antognini, J. Vengco

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg-1) of suxamethonium, vecuronium was infused to produce 75% block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg-1, pyridostigmine 0.24 mg kg-1 or neostigmine 0.05 mg kg-1 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction.

Original languageEnglish (US)
Pages (from-to)492-495
Number of pages4
JournalBritish Journal of Anaesthesia
Volume77
Issue number4
StatePublished - Oct 1996

Fingerprint

Edrophonium
Pyridostigmine Bromide
Vecuronium Bromide
Neostigmine
Succinylcholine
Cholinesterases
Sufentanil
Propofol
Drug Interactions
Therapeutics

Keywords

  • Antagonists neuromuscular block, edrophonium
  • Antagonists neuromuscular block, neostigmine
  • Antagonists neuromuscular block, pyridostigmine
  • Enzymes, cholinesterase
  • Neuromuscular block, suxamethonium

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine. / Fleming, Neal; Macres, Stephen M; Antognini, J. F.; Vengco, J.

In: British Journal of Anaesthesia, Vol. 77, No. 4, 10.1996, p. 492-495.

Research output: Contribution to journalArticle

@article{e915d5774686471fb39d3ffb545a28df,
title = "Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine",
abstract = "The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg-1) of suxamethonium, vecuronium was infused to produce 75{\%} block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg-1, pyridostigmine 0.24 mg kg-1 or neostigmine 0.05 mg kg-1 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction.",
keywords = "Antagonists neuromuscular block, edrophonium, Antagonists neuromuscular block, neostigmine, Antagonists neuromuscular block, pyridostigmine, Enzymes, cholinesterase, Neuromuscular block, suxamethonium",
author = "Neal Fleming and Macres, {Stephen M} and Antognini, {J. F.} and J. Vengco",
year = "1996",
month = "10",
language = "English (US)",
volume = "77",
pages = "492--495",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Neuromuscular blocking action of suxamethonium after antagonism of vecuronium by edrophonium, pyridostigmine or neostigmine

AU - Fleming, Neal

AU - Macres, Stephen M

AU - Antognini, J. F.

AU - Vengco, J.

PY - 1996/10

Y1 - 1996/10

N2 - The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg-1) of suxamethonium, vecuronium was infused to produce 75% block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg-1, pyridostigmine 0.24 mg kg-1 or neostigmine 0.05 mg kg-1 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction.

AB - The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg-1) of suxamethonium, vecuronium was infused to produce 75% block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg-1, pyridostigmine 0.24 mg kg-1 or neostigmine 0.05 mg kg-1 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction.

KW - Antagonists neuromuscular block, edrophonium

KW - Antagonists neuromuscular block, neostigmine

KW - Antagonists neuromuscular block, pyridostigmine

KW - Enzymes, cholinesterase

KW - Neuromuscular block, suxamethonium

UR - http://www.scopus.com/inward/record.url?scp=0029797877&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029797877&partnerID=8YFLogxK

M3 - Article

C2 - 8942334

AN - SCOPUS:0029797877

VL - 77

SP - 492

EP - 495

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 4

ER -