Reasonable reversal of neuromuscular block in the postanesthesia care unit

Aim To evaluate the antagonistic dose-effect and safety of neostigmine on vecuronium-induced residual neuromuscular blockade.Methods Sixty patients scheduled for a gastrointestinal surgery under general anesthesia were induced with midazolam,fentanyl,etomidate and vecuronium during general anesthesia,and were maintained with propofol and remifenfanil.The dose of vecuronium were injected as clinically required during surgery.The train-of-four ratio(TOFR) was monitored by acceleromyography.When TOFR recovered to 0.25,patients in Nl group,N3 group and N5 group were administrated neostigmine(10,30,50 μg·kg-1) and atropine(5,15,25 μg·kg-1) respectively,and those in control group(N0 group) were intravenously injected with 2 mL normal saline.The time of RI,TOFR recovery to 0.7 and 0.9 was monitored,the length of stay in the PACU(T),heart rate and blood pressure were recorded,and postoperative nausea and vomiting were also observed.Results Neostigmine significantly accelerated the recovery of RI,TOFR and the length of stay in the PACU(P0.05).The time of recovery and the length of stay in the PACU in N3 group and N5 group was significantly less than that in N1 group(P0.05).There was no significant difference in the incidence of postoperative nausea and vomiting among each group(P0.05).The heart rates in N3 group and N5 group were significantly increased one to two minutes after administration(P0.05),while there was no significant difference in blood pressure among each group(P0.05).Conclusion Three groups of different doses of neostigmine may antagonize vecuronium-induced residual neuromuscular blockade effectively,and lower dose of neostigmine(10 μg·kg-1) is recommended.