Inadequate Antagonism of Vecuronium-Induced Neuromuscular Block by Neostigmine During Sevoflurane or Isoflurane Anesthesia

Abstract

To examine the effects of discontinuing sevoflurane or isoflurane anesthesia (1 minimum alveolar anesthetic concentration [MAC] of end-tidal concentrations, together with 66% N2O/O2) on the reversal of vecuronium-induced neuromuscular blockade (an initial dose = 100 micrograms/kg), the electromyographic response of the abductor digiti minimi was monitored at 20-s intervals after train-of-four (TOF) stimulation of the ulnar nerve in 192 ASA grades I and II patients. When the amplitudes of the first response (T1) had recovered to 10% of the control, neostigmine (0;spontaneous recovery, 10, 20, 30, 40, or 55 micrograms/kg, eight patients each) was given and the ratio of the fourth TOF to the first response (TOFR) was monitored at 1-min intervals for 15 min in the presence of the volatile anesthetics, or after discontinuation of anesthetic administration. Spontaneous TOFR recovery was also assessed in another eight patients who were anesthetized with 66% N2O/O2-fentanyl-diazepam. Adequate antagonisms (TOFR > 75%) were achieved after discontinuation of both administrations, but not during anesthetic administration at the neostigmine doses tested. The dose-response curves for neostigmine (10, 20, 30, and 40 micrograms/kg) were constructed using the TOFR values at 5-11 min, from which the ED50 values (a neostigmine dose required for a TOFR value of 50%) were derived. Sevoflurane impaired neostigmine antagonism more than isoflurane, as demonstrated by the significantly higher ED50 values at 7-11 min (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)