• Ju Jae-Woo JW From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul (J-WJ, SY, DMH, H-PP), Keimyung University Dongsan Medica, Hyun-Chang Kim, Sehee Yoon, Deok Man Hong, and Hee-Pyoung Park.
• From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul (J-WJ, SY, DMH, H-PP), Keimyung University Dongsan Medical Center, Daegu (H-CK), South Korea.
• Eur J Anaesthesiol. 2017 Sep 1; 34 (9): 617-622.

BackgroundIonised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated.ObjectiveWe examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery.DesignRandomised double-blind trial.SettingA tertiary teaching hospital.PatientsIn total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor.InterventionsPatients were randomly allocated to receive either 5 mg kg of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 μg kg of neostigmine and 15 μg kg of atropine at the end of surgery.Main Outcome MeasuresThe primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point.ResultsThe neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration.ConclusionCalcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal.

37 keywords...

hide…