Antagonize vecuronium-induced residual neuromuscular blockade with neostigmine in pediatric and adult patients

Objective To study the dose-effect relationships and safety for neostigmine as antagonist of vecuronium-inducted residual neuromuscular blockade in children and adults.Methods The first dose of vecuronium was 0.1 mg&g.bolus doses of 0.05 mg/kg vecuronium were injected into 50 children and 50 adult patients as clinically needed during surgery.At an acceleromyography train-of-four ratio(TOFR)recovery of 0.55,neostigmine(10,20,30 or 50 μg/kg)and atropine(5,10,15 or 25 μg/kg)were administrated by random allocation.Group contr01 was administrated saline 2 m1.Time of TOFR recovery of 0.7.0.9 and 1.0 and complication of postoperative nausea and vomiting(PONV)in 6 and 24 hours were also recorded.Results Neostigmine accelerated the recovery of TOFR.It was significant different that the recovery time of four doses of neostigmine compared to group control(P＜0.01),especially the dose of 30 μg/kg～50 μg/kg(P＜0.05).There was no difference in dose-response relationships for neostigmine and the incidence of PONV in 6 hours and 24 hours between pediatric and adult patients(P＞0.05).At the fifth minute after antagonism,ED95 of neostigmine was(6.4±10.5)μg/kg and(2.7±1 9.2)μg/kg respectively in children and adult patients.Conclusion Different doses of neostigrnine ale equally effective against vecuronium in children and adult patients at TOFR recovery of 0.55.Low dose of neostigmine,no more than 30 μg/kg,is suitable for antagonizing residual neuromuscular blockade. Key words: Neostigmine; Antagonism; Vecuronium; Residual neuromuscular blockade; Anesthesia