Neostigmine antagonizes vecuronium-induced residual neuromuscular blockade in children

Objective To study the dose-effect relationship and safety of different doses of neostigmine in antagonizing vecuronium-induced residual neuromuscular blockade in children.Methods The first dose of vecuronium was 0.1 mg/kg,and bolus dose of 0.05 mg/kg vecuronium was injected into 50 children when clinically needed during the surgeries.After an acceleromyography train-of-four ratio(TOFR) recovery of 0.55,children were randomly assigned to five groups(n=10).Group V10,V20,V30 and V50were administrated with neostigmine(10,20,30 and 50 μg/kg) and atropine(5,10,15 and 25 μg/kg,respectively).Group C(group control) was administrated with 2 mL saline.Time of TOFR recovery to 0.7,0.9 and 1.0,and heart rate and blood pressure were recorded.Nausea and vomiting(PONV) 6 h and 24 h after operation was also recorded.Results The recovery time periods of TOFR to 0.7,0.9 and 1.0 were significantly shorter than those of the control group(P0.01);the recovery time period of TOFR to 0.9 in V20 group was significantly shorter than that in V10 group(P0.05);the recovery time periods of Group V30 and V50 were significantly shorter than that of Group V10(P0.05).There were no differences in the heart rate,blood pressure and the incidences of PONV 6 h and 24 h after operation among the five groups(P0.05).Conclusion When TOFR value recovers to 0.55,it is necessary to antagonize the residual block.Different doses of neostigmine can effectively antagonize vecuronium-induced residual neuromuscular blockade in children,but our results suggest low dose of neostigmine(30 μg/kg) is suitable for antagonizing RNMB.(Shanghai Med J,2010,33: 136-139)