Comparision of Different Dose of Neostigmine at Advanced Decurarization
Status:
Completed
Trial end date:
2009-11-01
Target enrollment:
Participant gender:
Summary
Neuromuscular blockers (NMB) are currently used in anesthesia. Residual paralysis (RP) due to
NMB is responsible for respiratory disorders after extubation. Neuromuscular blockade is
monitored by train-of-four (TOF) stimulation at the adductor pollicis. To exclude a RP a
mechanomyographic TOF ratio of 0.9 is mandatory. But mecanomyography is not available in
clinical routine. Acceleromyography is the most currently monitoring available in daily
practice but it has been proved that an acceloromyographic (AMG) TOF ratio of 1.0 is
necessary to exclude a RP. The incidence of RP in recovery room is underestimated. So to
perform a safe extubation, reversal of the neuromuscular blockade is necessary when an AMG
TOF ratio has not reached 1.0. Reversal of neuromuscular blockade is achieved with
neostigmine. The recommended dose is 0.04 mg/kg. The administration of neostigmine causes
parasympathomimetic effects which has to be reversed with atropine. When neuromuscular
blockade is light (AMG TOF ratio of 0.4 which corresponds to the absence of fade at the
visual evaluation of the TOF), a low dose of neostigmine might be sufficient with less side
effects expected. The goal of the study is to compare the delay between a light neuromuscular
block and an AMG TOF ratio of 1.0 for three neostigmine regimens of neostigmine 0.04, 0.02,
0.01 mg/kg with atropine respectively 0.02, 0.01, 0.005 mg/kg and a placebo.