You are on page 1of 1

c 


   
Several factors modify the rate of recovery of neuromuscular activity after reversal.
Intensity of Block
The more intense the block at the time of reversal, the
neostigmine is more effective than edrophonium or pyridostigmine in antagonizing intense
(90%) blockade.
Age
Recovery of neuromuscular activity occurs more rapidly with smaller doses of
anticholinesterases in infants and children than in
Although the elimination of anticholinesterases is reduced in this age group, this is
counterbalanced by the tendency for neuromuscular blockade to wear off more slowly.
This is especially true of steroid neuromuscular blocking agents, such as vecuronium and
rocuronium, which have a slower recovery index in the elderly.

Drugs that potentiate neuromuscular blockade


can slow reversal or produce recurarization if given after anticholinesterase administration.

Halogenated agents, when continued after neostigmine administration, prolong time to full
reversal.
aminoglycoside antibiotics or magnesium must be given shortly after reversal agents.117
Renal Failure
Anticholinesterases are actively secreted into the tubular lumen so that their clearance is reduced
in renal failure.153 Thus, duration of action of neostigmine and edrophonium is increased in renal
failure, Anticholinesterases: Other Effects
Cardiovascular
Anticholinesterases provoke profound vagal stimulation. The time course of the vagal effects
parallels the reversal of block: rapid for edrophonium and slower for neostigmine
Atropine has a rapid onset of action (1 minute), duration of 30 to 60 minutes,makes it appropriate
for use in combination with edrophonium,159 whereas glycopyrrolate (onset 2 to 3 minutes) is
more suitable with neostigmine or pyridostigmine

You might also like