Recovery characteristics following antagonism of vecuronium with edrophonium, neostigmine or pyridostigmine.

Vecuronium-induced neuromuscular blocks in 42 ASA physical status I and II females were antagonized with atropine and equipotent doses of edrophonium, neostigmine and pyridostigmine. Recovery characteristics including speed of reversal, dysrhythmias and mean arterial pressure changes were studied. Edrophonium was associated with the fastest neuromuscular recovery. No clinically significant cardiovascular changes were found in any group. It is imperative that any newly developed drug, along with its effects, dosage and interactions with other agents, be evaluated and documented. Vec-uronium (Norcuron®) is one of the new neuromus-cular blocking agents in use. It is a nondepolar-izing agent of rapid onset and short duration, with minimal adverse systemic reactions. Secondary to its pharmacodynamics, vecuronium continues to gain increasing use and popularity as a surgical muscle relaxant. Reversal of vecuronium can be accomplished with one of the anticholinesterase agents. The choice of which to use has been a personal one because there is limited documentation as to which of the reversal agents works best with vecuronium. A recent investigation by Kopman illustrates the point that ease of reversal is a function of several factors including the type of blocking agent used, the level of paralysis, the anticholinesterase chosen and the experimental conditions of the body. 1 Miller has emphasized that a myriad of studies have evolved concerning neuromuscular blocking agents, their antagonists and multiple combinations of the factors just mentioned. 2 Being able to apply these data to clinical anesthesia practice is of prime importance. In this study, edrophonium, neostigmine and pyridostigmine were evaluated as antagonists of vecuronium to determine if there was a significant difference between the three agents with regard to speed of reversal and cardiovascular stability. Methods This study utilized a quasi-experimental research design. The reversal agents served as the independent variables. Evaluation of the return of the train-of-four, the presence/absence of dysrhyth-mias and changes in mean arterial pressure (MAP) served as the dependent variables. Forty-two female patients undergoing laparoscopy were investigated after giving informed consent to a study approved by the Clinical Investigation and Human Use Committees of the affiliated hospital. All patients studied were ASA physical status I or II, non-obese and free of neuromuscular disease, upper extremity dys-function, and hepatic or renal dysfunction by history. The patients were normothermic and taking no medications known to interfere with neuromus-cular transmission. Serum potassium, calcium and magnesium were within normal levels. 127 The patients were assigned to one of three groups …