Clinical Research Of The Reversal Of Neuromuscular Blockade With Neostigmine In Elderly Patients

The subject of this study was to:(1) Compared the reversal of cisatracurium and vecuronium with neostigmine in elderly patients.(2) Compared the reversal of cisatracurium with neostigmine in elderly and adult patients.Part 1:Comparison of the reversal of cisatracurium and vecuronium with neostigmine in elderly patients.Objective:This study was designed to compare the reversal of cisatracurium and vecuronium induced neuromuscular block with neostigmine in elderly patients.Methods:Thirty elderly patients(age≥65yr) undergoing elective laparoscopic cholesystectomy were divided into four groups with 15 cases in every group.All patients were anesthetized with midazolam,propofol,fentanyl and cisatracurium/vecuronium.In group C1 and C2,neuromuscular block was induced with cisatracurium and in group V1 and V2 with vecuronium.The evoked mechanical response of the adductor pollicis to train-of-four(TOF) stimulation was recorded.When the magnitude of the first TOF response(T1) had recovered to 10%,the block was antagonized with neostigmine 0.035mg·kg-1 in group C1 and V1.Patients were extubated until TOF ratio of 80%were achieved.The time intervals from administration of neostigmine to the T1 response recovered to 25%,75%,90%were recorded.The time of TOF recovered to 70%,80% and RI(recovery index:the time from T1 25%to 75%) were recorded.Results:The recovery time of T1 25%,75%,90%and TOF 70%,80%and RI in group C1 was significantly shorter than that in group C2.There were significant differences between C1 and C2.The recovery time of T1 25%,75%,90%and TOF 70%,80%and RI in group V1 was significantly shorter than that in group V2.Conclusion:The reversal of cisatracurium and vecuronium induced nuromuscular block with neostigmine could reduce the recovery time and the risk of residual neuromuscular block. Part 2:Comparison of the reversal of cisatracurium with neostigmine in elderly and adult patients.Objective:This study was designed to compare the reversal of cisatracurium with neostigmine in elderly and adult patients.Methods:Thirty patients undergoing elective surgical procedures were divided into two groups with 15 elderly(age≥65yr) and 15 adult patients(age 18-64yr).All patients were anesthetized with midazolam,propofol,fentanyl and cisatracurium.The evoked mechanical response of the adductor pollicis to train-of-four(TOF) stimulation was recorded.When the magnitude of the first TOF response(T1) had recovered to 10%,the block was antagonized with neostigmine 0.035mg·kg^-1.Patients were extubated until TOF ratio of 80%was achieved.The time intervals from administration of neostigmine to the T1 response recovered to 25%,75%,90%were recorded.The time of TOF recovered to 70%,80%and RI(recovery index:the time from T1 25%to 75%) was also recorded.Results:There were no significant differences between two groups in the recovery time of T1 25%,75%and TOF 70%(P＞0.05).The recovery time of T1 90%and TOF 80%in elderly group was markedly longer than that in adult group(P＜0.05).Conclusion:The recovery time of neuromuscular relaxation following administration of cisatracurium antagonized with neostigmine in elderly patients might be longer than that in adult patients.