Evaluation of Low Doses of Neostigmine for Reversal of Residual Neuromuscular Blockade

Neuromuscular blocking agents (NMB) are now routinely used to facilitate tracheal intubation, mechanical ventilation and skeletal muscle relaxation throughout the entire surgical procedures. Murphy et al reported that residual paralysis resulting from inadequate reversal is an important contributing factor to critical postoperative respiratory events (inadequate pulmonary functions, reduced pharyngeal muscle coordination, obstruction of upper airways, increased risk of aspiration and impaired hypoxic ventilatory response) [1]. Neostigmine (anticholinesterases) by increasing acetylcholine concentration at synaptic cleft causes more complete antagonism of neuromuscular blockade. Though the dose of neostigmine varies widely, 40-60μg kg-1 is routinely prescribed [2].