Now Consultant, Chelmsford, Essex.
Cardiovascular changes at antagonism of atracurium
Effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5:1
Article first published online: 22 FEB 2007
Volume 46, Issue 10, pages 877–880, October 1991
How to Cite
Suresh, D., Carter, J. A., Whitehead, J. P., Goldhill, D. R. and Flynn, P. J. (1991), Cardiovascular changes at antagonism of atracurium. Anaesthesia, 46: 877–880. doi: 10.1111/j.1365-2044.1991.tb09609.x
Presented in part at the Annual Scientific Meeting of the Association of Anaesthetists, 1990.
- Issue published online: 22 FEB 2007
- Article first published online: 22 FEB 2007
- Accepted 18 February 1991
- Antagonists; neuromuscular relaxants, neostigmine;
- Parasympathetic nervous system; glycopyrronium;
- Neuromuscular relaxants; atracurium
The cardiovascular changes in the 10 minutes following antagonism of an atracurium-induced block were studied in 32 patients. A 5: 1 ratio combination of either 15, 35, 55 or 75 μg/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 μg/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 μg/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 μg/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 μg/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46–80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between-group difference; these were clinically unimportant. When antagonising an atracurium-induced block with clinically useful doses of neostigmine, the standard 5: 1 ratio combination with glycopyrronium will result in an initial tachycardia.