Use Of Neostigmine Research Articles

Epidural anaesthesia and postoperative colorectal motility--a possible hazard to a colorectal anastomosis.

The effects of epidural anaesthesia (EDA, mepivacaine) and EDA in combination with atropine and neostigmine on postoperative intestinal motility were studied in 17 patients undergoing operation for cancer of the rectum or sigmoid colon. Motility was recorded by a volumetric technique. Epidural anaesthesia (EDA) increased motor activity in the small bowel as well as in the left colon and rectum. Phasic motility dominated in the small intestine whereas tonic and segmental contractions were recorded from the large bowel. EDA induced a powerful tonic contraction with a concomitant shortening of the rectum. This effect was inhibited by atropine. The influence of atropine/neostigmine on left colonic motor activity was studied in six patients before and during EDA in a cross-over fashion. When administered alone, atropine/neostigmine did not cause any motility increase. Atropine/neostigmine administered during EDA, however, elicited a significant increase of motility. The increase of intestinal motor activity induced by EDA may expose a newly constructed colorectal anastomosis to undue strain in the immediate postoperative period. When EDA is used in combination with general anaesthesia, particular attention should be directed towards the use of neostigmine for reversing the effect of nondepolarizing muscle relaxants. Atropine appears under such circumstances not to protect from the excitatory effects of this drug on colorectal motility.

Use of neostigmine to increase the rate of lung cancer detection by sputum cytology

Neostigmine induction was investigated as a method for increasing the rate of detection of lung cancer in respiratory cytology samples. Eleven patients with dry and essentially nonproductive cough were given neostigmine, 15 mg by mouth or 0.5 mg by hypodermic injection. The quality of sputum produced was increased in all cases; the sputum was also more easily expectorated. Eight patients suspected of having lung cancer had previously negative cytologic examinations of sputum obtained by conventional methods. Following the administration of neostigmine, malignant cells indicating squamous-cell carcinoma were found in the sputum samples of three of these patients while dysplastic cells were detected in the samples from two patients. It is postulated that neostigmine intake may increase the excretion of mucous glands in the bronchial submucosa as well as the bronchial epithelium itself.

Combined Use of Neostigmine and Ocular Motility Measurements in the Diagnosis of Myasthenia Gravis

Forty-four patients with diplopia caused by myasthenia gravis, ocular myopathies, and ocular motor nerve palsies underwent complete orthoptic evaluations before and after intramuscular injection of neostigmine (Prostigmin) methylsulfate. A test score combining the results of binocular and uniocular measurements was developed that allowed correct correct classification of 70% (31) of patients studied.

EVALUATION OF ATRACURIUM IN ANAESTHETIZED MAN

Atracurium is a potent competitive neuromuscular blocking agent in anesthetized man with no cardiovascular effects at doses required for paralysis. Endotracheal intubation can be accomplished after i.v. doses of 0.6 and 0.3 mg kg-1, within 1 and 2 min respectively. Paralysis is readily antagonized by neostigmine and is enhanced by halothane. The consistent response in terms of block and recovery which emerged when the drug was given as increments of 0.05 or 0.1 mg kg-1 indicates the absence of cumulative effects. The course of action of atracurium was appreciably shorter than that of other recognized competitive blocking agents. Doses of 0.3--0.6 mg kg-1 i.v. provided adequate relaxation during surgical intervention for 15--45 min; spontaneous recovery without the use of neostigmine was observed in some patients. In addition to the non-enzymic decomposition by "Hofmann Elimination", atracurium may also undergo an enzymic ester hydrolysis but, unlike suxamethonium, it may not be destroyed by pseudocholinesterase.

The effect of neostigmine on suxamethonium induced neuromuscular block in the dog

The effects of neostigmine on suxamethonium induced neuromuscular block were investigated in the intact, anaesthetised dog using the train-of-four twitch to record neuromuscular activity. Marked antagonism of the block was observed when the train-of-four ratio was 0.38 and less. To avoid potentiating the block, the use of neostigmine is not recommended without first determining the state of neuromuscular activity with a peripheral nerve stimulator using train-of-four stimulation.

Synergism of the toxicity of physostigmine and neostigmine by lithium or by a reserpine-like agent (Ro4-1284)

A single sublethal i.p. dose of lithium chloride (300 mg/kg or 7.1 meq/kg) followed 12 h later by an otherwise sublethal s.c. dose of physostigmine sulfate (1.0 mg/kg) resulted in 90% mortality among male rats following a pronounced cholinergic syndrome, including convulsions. This confirms a previous report of a lethal synergism of physostigmine after subacute dosing with lithium. Mortality could be completely prevented by 1.0 mg/kg of atropine sulfate given 3- min before physostigmine, but was incompletely, if at all, reduced by selective peripheral cholinergic blockers, methylatropine bromide (0.5, 1.5 mg/kg) or glycopyrrolate (1 mg/kg). This suggested a predominantly central site for the toxic interaction. However, a similar synergism of lethality caused by neostigmine methylsulfate (0.3 mg/kg, s.c.) after treatment with lithium, which could be eliminated by methylatropine or glycopyrrolate, indicates that lithium may also produce lethal synergism of a cholinesterase (ChE) inhibitor that does not act centrally. Ro4-1284, an agent that has reserpine-like actions, was tested in combination with physostigmine or neostigmine; it showed synergism of toxicity nearly the same as in the case of lithium plus the cholinergic agents. These findings support the hypothesis that lithium causes the toxic synergism via a reduction of adrenergic activity, leading to an imbalance between adrenergic and cholinergic influences and a consequent failure to tolerate the effects of the ChE inhibitors. A potential hazard for the clinical use of physostigmine and neostigmine, concurrently with lithium or reserpine-like agents, it suggested.

What are your thoughts on the use of a mixture of glycopyrrolate and pyridosligmine versus the use of atropine and neostigmine for the reversal of action of nondepolarizing muscle relaxants?

What are your thoughts on the use of a mixture of glycopyrrolate and pyridosligmine versus the use of atropine and neostigmine for the reversal of action of nondepolarizing muscle relaxants?

SOME ASPECTS OF POST‐EXERCISE HYPERAEMIA IN MAN

SummaryA technique is described for the assay of vasoactive substances in venous blood draining from the forearm muscles of one arm by the injection of a sample of the venous blood into the brachial artery of the opposite arm and the measurement of blood flow through that forearm. Using this technique, no vasoactive substance was detected in venous blood from exercising muscle.An altered response of the superfused guinea‐pig ileum to venous blood draining from human skeletal muscle at the end of a 4‐minute period of rhythmic exercise was observed in 8 of 11 experiments. The precise identity of the substance responsible was not determined, but the nature of its effect on the guinea‐pig ileum was more suggestive of acetylcholine than of histamine.The role of acetylcholine in the post‐exercise hyperaemia of the human forearm was examined by determining the effect of intra‐arterial infusions of the acetylcholine‐blocking agents atropine and hyoscine and the anticholinesterase neostigmine. Intra‐arterial infusions of atropine and hyoscine did not alter the post‐exercise hyperaemia and it is concluded that acetylcholine normally plays no part in the production of the hyperaemia. Post‐exercise hyperaemia was increased by the use of neostigmine, suggesting that, in this circumstance, acetylcholine liberated from the motor end‐plates causes vasodilatation which is additive to the post‐exercise hyperaemia.

THE 90 MINUTE FOLLOW THROUGH: A SIMPLE TECHNIQUE FOR EXAMINATION OF THE SMALL INTESTINE.

Radiological examination of the small intestine in children presents problems not commonly encountered in adult patients. When ordinary techniques are employed flocculation and segmentation may occur in children with malabsorption syndromes and also quite commonly in normal children. (The view that these phenomena give a useful estimate of malabsorption has been quite outmoded by the standard biochemical techniques used to assess this aspect of small intestinal function.) Flocculation and segmentation prevent satisfactory definition of the wall of the small intestine. Detail may be adequate only in the jejunum even when employing a contrast medium such as Raybar, specifically recommended for examination of the small intestine. The ordinary follow-through examination of the small intestine is usually a time-consuming procedure. Harden (1960) and more recently Trickey, Halls and Hodson (1963) have advocated the use of the small bowel enema. However, children do not tolerate intubation well, an extensive small bowel abnormality may be obscured by the slight distension of the bowel which this technique produces, and the potential danger of fluid imbalance in children with extensive disease of the gut is always to be feared. Other radiologists (Margulis and Mandelstam, 1961) have advocated the use of neostigmine to improve the quality of the examination of the small intestine, but unnecessary injections are undesirable. In this paper a simple technique for examination of the small intestine is described. It has given satisfactory results in over 100 children of one year upwards and flocculation and segmentation have very rarely been troublesome.

Restoration of Function After Brain Injury.

There are few areas in clinical medicine more in need of clarification than the theory and practice in the treatment of the brain damaged. This book is an English translation of a book written in 1948 by the well-known Russian experimental psychologist, A. R. Luria, in which he attempts to provide a rational hypothesis on which to base and develop a system of evaluation and reeducation of brain injured patients, particularly after trauma. The problem is developed in three steps. The first is restoration of function by reduction of inhibition, a phenomenon that is suggested to be a result of synapses within the brain which are inactive but without gross structural damage. To reduce this inhibition particular emphasis is given to the use of intravenous neostigmine (Prostigmine), a treatment that has not found similar favor in other treatment centers. A second major step is called restoration of function by reorganization

Evaluation of the small bowel barium motor meal, with emphasis on the effect of volume of barium suspension ingested.

Various radiographic methods have been devised for examining the small bowel. Many of the technics, such as the use of the Miller-Abbott tube (1, 7, 25) and the small bowel enema (15, 20, 26, 34, 35), require intubation, a tedious procedure for the active roentgenologist and an uncomfortable experience for the patient. These methods are valuable, however, in selected cases, to demonstrate organic lesions. Examinations utilizing barium in saline followed by large volumes of iced saline, as described by Weintraub and Williams (39), are not physiologic, and a significant percentage of patients cannot tolerate the saline (2, 19). Administration of complex mixtures is not necessary for accurate evaluation of the small bowel; e.g., Brown (8) conducts his examination with a non-flocculating barium suspension (Raybar) mixed with cold water and soda. The use of neostigmine, as advocated by Margulis and his associates (28, 40), shortens the transit time of the barium meal, but only at the expense of alteration in m...

Roentgenographic pattern and motility in small bowel studies.

Roentgenographic study of the small intestine often requires three to six hours. In addition, it is frequently noted that there is a lack of uniform filling of the entire small bowel, so that even after several roentgenograms are made the discontinuity of the barium column leads to an inconclusive diagnosis. The ingestion of cold saline (8) has been suggested as a means of hastening small intestinal motility. Some of the familiar barium preparations are said to show flocculation in the presence of mucus, thus producing an unusual small bowel pattern. Colloidal suspensions of barium have been used (1, 2) for obtaining a more uniform pattern. The small bowel enema (6, 7), after intubation of the duodenum, has been proposed as affording more rapid uniform filling of the small intestine. The use of purgatives (3) and parenteral neostigmine (4) have also been suggested, to decrease transit time and improve the diagnostic pattern. In Charity Hospital (New Orleans), several hundred roentgenographic examinations are performed daily by a relatively small staff of radiologists and technicians. It seemed desirable to develop a simple method of outlining the small intestine in a rapid, uniform manner if this could be done without any sacrifice of accuracy in diagnosis. With the oral ingestion of 6 ounces or less of the usual barium suspension, a tendency to segmentation is noted (Fig. 1), and four to six hours, often more, arc required for the study. The question arose whether an increase in the volume of the meal might help overcome these objections. This could be done by increasing the original barium meal or by giving an additional amount of barium suspension, saline, or water after a given interval of time. During routine fluoroscopy of the stomach it was noted that when the patient was in the right lateral recumbent position the stomach emptied at a rapid, uniform rate. It seemed logical that this position might be used to produce a more rapid and uniform filling of the small intestine. Clinical Experiment I The opportunity arose to investigate some of the above possibilities when, in the Spring of 1959, the Department of Physiology requested that the first-year class of Tulane Medical School be divided into small groups to observe fluoroscopy of the upper gastrointestinal tract. These students were asked to report to the Department of Radiology on three successive afternoons, the only preparation required being that they ingest nothing by mouth during the preceding six hours. A total of 106 students were divided into 12 groups of 5 to 12 each. Having been questioned to exclude gastrointestinal symptoms, each subject was given a barium meal and a supine roentgenogram of the abdomen was obtained one hour later. Some of the groups were asked to remain upright and some to assume the right lateral recumbent position. Almost all were given 10 ounces of barium suspension initially. Some received the usual aqueous suspension.

Local administration of anticholinesterase agents in ocular myasthenia gravis.

Myasthenia gravis, a disease characterized by paralysis of skeletal muscles, is of considerable ophthalmologic interest because the initial symptoms usually are found in the extraocular muscles and, in the late stages of the disease, practically all patients show involvement of the extraocular muscles. The ophthalmologist is one of the first to encounter the evidences of this disease and must therefore be familiar with the means of differential diagnosis and therapy. Diagnosis is usually established in a suspected case by finding dramatic improvement following the subcutaneous injection of neostigmine or the intravenous injection of edrophonium (Tensilon). Aggravation of symptoms may occur with the administration of quinine or curare. Quinine and curare are usually utilized only if the results of tests with neostigmine or edrophonium are inconclusive. Therapy of this condition, once the diagnosis has been established, is largely dependent upon the use of neostigmine (Prostigmin). The dosage which is required usually

Neostigmine therapy for apnea occurring after administration of neomycin; report of a case.

At the time of this writing only six cases of apnea occurring after the intraperitoneal administration of neomycin have been reported. 1 However, the widespread use of this antibiotic would indicate that this complication will be encountered more frequently. When apnea does occur from intraperitoneal administration of neomycin, artificial ventilation is the treatment of choice. Given adequate time, recovery will occur just as it does after curare overdosage. Pittinger 2 has shown that, in anesthetized animals, intravenously given neomycin readily produced neuromuscular blockade and respiratory depression. Ether anesthesia appeared to potentiate this curare-like action. In these experiments neostigmine antagonized both the neuromuscular blockade and the respiratory depression produced by neomycin, and by pretreatment with neostigmine this curare-like action did not occur. The clinical use of neostigmine in the treatment of respiratory depression from intraperitoneal administration of neomycin has not been reported, to our knowledge. In the following case it appears

THE MECHANISMS CONCERNED IN THE ABNORMAL PROLONGATION OF EFFECT FOLLOWING SUXAMETHONIUM ADMINISTRATION, WITH REFERENCE TO THE USE OF NEOSTIGMINE

THE MECHANISMS CONCERNED IN THE ABNORMAL PROLONGATION OF EFFECT FOLLOWING SUXAMETHONIUM ADMINISTRATION, WITH REFERENCE TO THE USE OF NEOSTIGMINE

TREATMENT FOR HYPERTENSION

To the Editor:— In his recent article on the treatment of hypertension ( J. A. M. A. 158: 359-367 [June 4] 1955) Dr. Grimson has taken issue with me on two points: (1) the use of neostigmine to overcome constipation produced by the ganglion-blocking agent, and (2) administration of the morning dose of the orally given blocking agent after, not before, breakfast. I have advocated 15 to 30 mg. of neostigmine taken orally on an empty stomach as being generally the most effective method for overcoming the constipating effects of the ganglion-blocking agents, particularly pentolinium. Dr. Grimson, however, has found in anesthetized dogs, rendered hypotensive with pentolinium, that the intravenous injection of neostigmine will result in a rise of blood pressure back to or toward control levels. On the basis of these studies Dr. Grimson concludes that we are producing the same effect in patients. During the past three years we

Use of cholinergic drugs in paroxysmal supraventricular tachycardia; serious untoward reactions and fatality from treatment with methacholine and neostigmine.

The effectiveness and usefulness of methacholine chloride in terminating attacks of paroxysmal tachycardia of supraventricular origin have become well established since Starr's introductory report in 1933. 1 The distressing occurrence of varying degrees of heart block following the original injections of 100 mg. or more was largely overcome by the use of doses of 20 to 40 mg. 2 Even these smaller doses often evoked unpleasant cholinergic effects. This led to the introduction of neostigmine as a substitute for 3 or adjuvant to 4 methacholine. Both agents are capable of evoking drastic effects by their action on the autonomic nervous system. Their proper use requires a clear understanding of their pharmacodynamic activity. Standard textbooks that deal with the treatment of acute attacks of supraventricular tachycardia almost invariably mention the use of both methacholine and neostigmine, as well as the commoner methods of therapy, such as various forms of vagal stimulation