British journal of anaesthesia
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The tetanic and single twitch responses of the adductor pollicis muscle were used to study the neuromuscular effects of neostigmine in 26 patients anaesthetized with thiopentone and nitrous oxide. Neostigmine 2.5 mg i.v. given 5 min after exposure to halothane antagonized non-depolarizing neuromuscular block, whereas a second dose give 2-5 min later depressed the peak tetanic contraction and re-established tetanic fade. In the absence of halothane the second dose of neostigmine had less effect. ⋯ In patients who were not given neuromuscular blocking drugs, one or two injections of neostigmine 2.5 mg caused a substantial reduction in the peak tetanic contraction and severe tetanic fade which persisted for about 20 min; the single twitch was slightly potentiated. The neostigmine block of the tetanic response could be antagonized by gallamine and potentiated by suxamethonium. These findings indicate that neostigmine in clinical doses can produce an acetylcholine-induced block which be a potential hazard in anaesthetic practice.
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Randomized Controlled Trial Clinical Trial
Evaluation of glycopyrrolate and atropine as adjuncts to reversal of non-depolarizing neuromuscular blocking agents in a "true-to-life" situation.
Glycopyrrolate, a quaternary ammonium anticholinergic compound, and atropine were evaluated in combination with neostigmine for antagonism of non-depolarizing neuromuscular block. A total of 641 patients were investigated in a "true-to-life" situation. The patients receiving glycopyrrolate with neostigmine had smaller changes in heart rate than those who received atropine. This was particularly apparent in patients with cardiovascular disease.
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Comparative Study
Comparison of the cardiovascular actions of ORG NC 45 with those produced by other non-depolarizing neuromuscular blocking agents in experimental animals.
The cardiovascular actions of 1- [(2 beta,3 alpha, 16 beta,17 beta)-3,17-bis(acetyloxy)-2-(1-piperidinyl)-androstan-16-yl]-1-methyl-piperidinium bromide (Org NC 45) are reviewed and compared with those of other non-depolarizing neuromuscular blocking drugs. Results obtained in anaesthetized cats and dogs have demonstrated that, in contrast to other neuromuscular blocking drugs, Org NC 45, even in doses 20 times greater than those required for neuromuscular block, has no effects on heart rate, arterial pressure, autonomic ganglia, adrenoceptors or baroreceptors activity. Studies in pithed rats and on guineapig atria have further shown that Org NC 45 has little effect on cardiac muscarinic receptors or on noradrenaline re-uptake mechanisms. These results suggest that Org NC 45 possesses significant advantages over presently used non-depolarizing neuromuscular blocking drugs, since its clinical use should not be associated with cardiovascular side-effects.