Abstract
BackgroundCalcium increases the probability of transmitter release at the neuromuscular junction. It is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups.MethodsPatients were randomly allocated to a control group, a 5 mg/kg calcium gluconate group (calcium 5 group), or a 10 mg/kg calcium gluconate group (calcium 10 group). In patients with a TOF ratio (TOFr) between 0.2–0.7, 0.04 mg/kg of neostigmine was administered and both 0.2 mg of glycopyrrolate and 0.4 mg of atropine per 1 mg of neostigmine were administered. And additional 5 or 10 mg/kg of calcium gluconate were administrated to the calcium 5 and 10 groups. The primary endpoint was neuromuscular recovery time (the time between reversal and TOFr≥0.9). The secondary endpoints were the incidence of PORC at 5, 10, and 20 min after reversal administration and the train-of-four ratio (TOFr) at each time point.ResultsThe neuromuscular recovery time was 5.3 min in the control group, 3.9 min in the calcium 5 group, and 4.1 min in the calcium 10 group, respectively (P = 0.004). The incidence of PORC at 5 min after neostigmine administration was 12 in the control group, 4 in the calcium 5 group, and 4 in the calcium 10 group, respectively, with statistical significance (P = 0.014).ConclusionsThe co-administration of calcium gluconate with neostigmine safely promoted early NMB recovery, and the neuromuscular recovery time of the calcium 10 group tended to be more evenly distributed than that of the calcium 5 group.Trial registrationhttps://cris.nih.go.kr/cris/index.jsp(KCT0004182). Date of registration: August 122,019.
Highlights
Calcium increases the probability of transmitter release at the neuromuscular junction
To determine whether ionized calcium at different doses may have a quantitative effect, this study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups: a 5 mg/kg calcium gluconate group, a 10 mg/kg calcium gluconate group, and a control group
If two or more types of cooperative surgery were performed, or if the patient was admitted to the intensive care unit (ICU) after surgery, those with levels beyond the normo-calcemic range during the blood test immediately before emergence from anesthesia or during conversion from laparoscopic to open surgery were eligible for dropout during the study
Summary
Calcium increases the probability of transmitter release at the neuromuscular junction It is not known whether there is a dose-dependent relationship between the dosage of calcium gluconate and the probability of transmitter release for non-depolarizing neuromuscular blockade (NMB) recovery by acetylcholinesterase inhibitors (AchEIs). This study compared the neuromuscular recovery time and the incidence of postoperative residual curarization (PORC) according to the dosage of calcium gluconate co-administered with neostigmine in three patient groups. It has been well-reported that the release of acetylcholine (Ach) at the neuromuscular junction is calciumdependent [1]. It is essential for anesthesiologists to take these various factors into consideration when recovering NMB
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