Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis

Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent... BACKGROUNDNeostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine.OBJECTIVE(S)The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9.DESIGNWe performed a systematic search of the literature from January 1992 to December 2015.DATA SOURCES OR SETTINGPubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: ‘neostigmine’, ‘sugammadex’, ‘edrophonium’ or ‘pyridostigmine’ AND ‘neuromuscular block’, ‘reversal’ or ‘reverse’.ELIGIBILITY CRITERIAStudies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained).RESULTS19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) <10%] 70 μg kg−1 neostigmine was used (five trials, 118 patients), and the mean reversal time was 17.1 min (95% confidence interval (CI) [12.4 to 21.8]). In patients with moderate residual block (T1 10% to <25%) the mean neostigmine dose was 56 μg kg−1 (seven trials, 342 patients), and the mean reversal time was 11.3 min (95% CI [9.2 to 13.4]). In patients with a shallow residual block (T1 ≥ 25%) the mean neostigmine dose was 40 μg kg−1 (13 trials, 535 patients), and the mean reversal time was 8.0 min (95% CI [6.8 to 9.2]).CONCLUSIONBased on the findings of this systematic review, we recommend that the administration of neostigmine be delayed until an advanced degree of prereversal recovery has occurred (i.e. a T1 >25% of baseline), or that a recovery time longer than 15 min be accepted. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Anaesthesiology Wolters Kluwer Health

Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis

Loading next page...
 
/lp/wolters_kluwer/neostigmine-based-reversal-of-intermediate-acting-neuromuscular-JkeTQOtWsv
Publisher
Wolters Kluwer Health
Copyright
Copyright © 2018 European Society of Anaesthesiology. All rights reserved.
ISSN
0265-0215
eISSN
1365-2346
D.O.I.
10.1097/EJA.0000000000000741
Publisher site
See Article on Publisher Site

Abstract

BACKGROUNDNeostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine.OBJECTIVE(S)The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9.DESIGNWe performed a systematic search of the literature from January 1992 to December 2015.DATA SOURCES OR SETTINGPubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: ‘neostigmine’, ‘sugammadex’, ‘edrophonium’ or ‘pyridostigmine’ AND ‘neuromuscular block’, ‘reversal’ or ‘reverse’.ELIGIBILITY CRITERIAStudies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained).RESULTS19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) <10%] 70 μg kg−1 neostigmine was used (five trials, 118 patients), and the mean reversal time was 17.1 min (95% confidence interval (CI) [12.4 to 21.8]). In patients with moderate residual block (T1 10% to <25%) the mean neostigmine dose was 56 μg kg−1 (seven trials, 342 patients), and the mean reversal time was 11.3 min (95% CI [9.2 to 13.4]). In patients with a shallow residual block (T1 ≥ 25%) the mean neostigmine dose was 40 μg kg−1 (13 trials, 535 patients), and the mean reversal time was 8.0 min (95% CI [6.8 to 9.2]).CONCLUSIONBased on the findings of this systematic review, we recommend that the administration of neostigmine be delayed until an advanced degree of prereversal recovery has occurred (i.e. a T1 >25% of baseline), or that a recovery time longer than 15 min be accepted.

Journal

European Journal of AnaesthesiologyWolters Kluwer Health

Published: Mar 1, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off