Residual Paralysis Induced by Either Vecuronium or Rocuronium After Reversal with Pyridostigmine

• Published in: Anesthesia and analgesia Vol. 95; no. 6; pp. 1656 - 1660
• Main Authors: Kim, Kyo S, Lew, Se H, Cho, Hee Y, Cheong, Mi A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.12.2002; Lippincott
• Subjects: Adult; Androstanols - pharmacology; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Female; Humans; Male; Medical sciences; Middle Aged; Neuromuscular Junction - drug effects; Neuromuscular Junction - physiology; Neuromuscular Nondepolarizing Agents - pharmacology; Neuropharmacology; Pharmacology. Drug treatments; Pyridostigmine Bromide - pharmacology; Rocuronium; Vecuronium Bromide - pharmacology; Human; Postoperative; Steroid; Non depolarizing muscle relaxant; Enzyme; Rocuronium bromide; Blocking; Enzyme inhibitor; General anesthesia; Esterases; Neuromuscular transmission; Vecuronium bromide; Organic carbamate; Cholinesterase; Carboxylic ester hydrolases; Reversion; Pyridostigmine bromide; Hydrolases; Complication; Neuromuscular blocking; Duration of action; Prolonged
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200212000-00033

We investigated postoperative residual curarization after administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive patients without perioperative neuromuscular monitoring. On arrival in the recovery room, neuromuscular function was assessed both by acceleromyography in a train-of-four (TOF) pattern and also clinically by the ability to sustain a head-lift for >5 s and the tongue-depressor test. Postoperative residual curarization was defined as a TOF ratio <0.7. One fifth of 602 patients (vecuronium, 24.7%; rocuronium, 14.7%) had a TOF <0.7 in the recovery room. There were no significant differences in the TOF ratios between 10 mg and 20 mg of pyridostigmine. The patients with residual block had several associated factorsthe absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. We conclude that significant residual neuromuscular block after vecuronium or rocuronium was not eliminated even with reversal by a large dose of pyridostigmine.