Giridharan, T (2006) A Study Comparing Three Different Doses of Neostigmine (50μgm/kg, 25μgm/kg, 12.5μgm/kg) as Reversal Agent for Facilitation of Recovery from Residual Neuromuscular Blockade with Atracurium. Masters thesis, Stanley Medical College, Chennai.
|
Text
201000206giridharan.pdf Download (415kB) | Preview |
Abstract
INTRODUCTION: Anti-cholinestrase drugs like neostigmine are given at the end of surgical procedures to accelerate recovery from residual neuromuscular blockade produced by non-depolarising neuromuscular blocking drugs. When atracurium is used as muscle relaxant which has a novel mechanism of excretion which does not depend either on renal or hepatic function. The atracurium induced muscle relaxation can recover spontaneously but slowly. Anti- cholinesterase is needed just to speed up recovery from residual blockade. Since the reversal agent like neostigmine has its own drawbacks of muscarinic side effects of bradycardia , hypotension, increased glandular secretions. The dose of neostigmine reduction might help in reducing these side-effects without affecting its purpose of reversing the residual neuromuscular blockade. In addition use of neuromuscular monitor , helps us to objectively judge the recovery of the neuromuscular junction , from residual non – depolarizing blockade when used in addition to the clinical signs of recovery of muscle power. AIM OF THE STUDY: To study and compare three different doses of neostigmine as reversal agent to residual neuromuscular blockade of atracurium. 1. On recovery of residual neuromuscular blockade produced by atracurium (intubating dose of 0.5 mg/kg, top-up dose of 0.15 mg/kg). 2. On the haemo- dynamic changes. 3. On the adverse side effects. MATERIALS AND METHODS: This study was conducted at Government Stanley Hospital, Chennai in the patients undergoing adeno-tonsillectomy, and tonsillectomy. After institutional approval and informed consent, 90 patients were enrolled in the study. INCLUSION CRITERIA: All ASA physical status (1 & 2) patients aged between 5 – 15 years scheduled for tonsillectomies and adeno - tonsillectomies under general anaesthesia. EXCLUSION CRITERIA: 1. Neuromuscular disease. 2. Patients receiving any medication known to interact with neuromuscular blocking agents 3. Known allergy to any medication. 4. Anticipated difficult intubation. 5. Morbidly obese. 6. ASA physical status 3, 4, & and 5. 7. Age below 5 years and more than 15 years. STATISTICAL ANALYSIS: The data was computed and all values expressed as mean +/- S.D. The data was analyzed using student independent t test , anova F test and Chi-square test as appropriate. SUMMARY: 1. The lower doses of neostigmine (25 μgm/kg, 12.5 μgm/kg) provided equally effective reversal of atracurium induced neuromuscular blockade as the higher dose (50μgm/kg). 2. The mean time required for recovery of adequate muscle power after neostigmine in all three groups were approximately equal and difference among them were statistically insignificant (5.97+/-1.7515, 6.2+/-1.95. 6.93+/-2.49). 3. The mean time required for extubation in all the three groups approximately equal (7.93+/-1.837, 8.27+/-2.196, 8.93+/-2.572 respectively). 4. The mean time for the recovery of the two responses to DBS without any fade in response was also approximately equal in all the three groups (4.83+/-1.821, 5.63+/-1.866, 6.03+/-2.236). 5. The heart rate showed a significantly lower mean value in group A (neostigmine 50μgm/kg) 90.63+/-8.37 compared with basal value 109.76+/-10.9. 6. The group A had 2 patients with significant bradycardia who received the higher dose (50μgm/kg) of neostigmine. 7. No patient in any of the three groups had side effects like nausea, vomiting, or hypotension. CONCLUSION: 1. Satisfactory facilitation of recovery from residual neuromuscular blockade produced by atracurium (given in intubating dose 0.5mg/kg and incremental dose of 0.15 mg/kg) are achieved with reduced doses of neostigmine (25μgm/kg and 12.5 μgm/kg). 2. Lower doses of neostigmine avoid the significant decrease in heart rate.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Three Different Doses ; Neostigmine ; 50μgm/kg ; 25μgm/kg ; 12.5μgm/kg ; Reversal Agent ; Facilitation ; Recovery ; Residual Neuromuscular Blockade ; Atracurium. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 15:07 |
| Last Modified: | 28 Apr 2018 01:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7221 |
Actions (login required)
 |
View Item |
