| Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure. | |
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MedLine Citation:
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PMID: 20980910 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Reversal of residual neuromuscular blockade by acetylcholinesterase inhibitors (e.g., neostigmine) improves respiratory function. However, neostigmine may also impair muscle strength. We hypothesized that neostigmine administered after recovery of the train-of-four (TOF) ratio impairs upper airway integrity and genioglossus muscle function. METHODS: We measured, in 10 healthy male volunteers, epiglottic and nasal mask pressures, genioglossus electromyogram, air flow, respiratory timing, and changes in lung volume before, during (TOF ratio: 0.5), and after recovery of the TOF ratio to unity, and after administration of neostigmine 0.03 mg/kg IV (with glycopyrrolate 0.0075 mg/kg). Upper airway critical closing pressure (Pcrit) was calculated from flow-limited breaths during random pharyngeal negative pressure challenges. RESULTS: Pcrit increased significantly after administration of neostigmine/glycopyrrolate compared with both TOF recovery (mean ± SD, by 27 ± 21%; P = 0.02) and baseline (by 38 ± 17%; P = 0.002). In parallel, phasic genioglossus activity evoked by negative pharyngeal pressure decreased (by 37 ± 29%, P = 0.005) compared with recovery, almost to a level observed at a TOF ratio of 0.5. Lung volume, respiratory timing, tidal volume, and minute ventilation remained unchanged after neostigmine/glycopyrrolate injection. CONCLUSION: Neostigmine/glycopyrrolate, when administered after recovery from neuromuscular block, increases upper airway collapsibility and impairs genioglossus muscle activation in response to negative pharyngeal pressure. Reversal with acetylcholinesterase inhibitors may be undesirable in the absence of neuromuscular blockade. |
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Authors:
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Frank Herbstreit; Daniela Zigrahn; Christof Ochterbeck; Jürgen Peters; Matthias Eikermann |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Anesthesiology Volume: 113 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2010-12-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 1280-8 Citation Subset: AIM; IM |
Affiliation:
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Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany. frank.herbstreit@uni-due.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Air Pressure Androstanols Anesthesia Recovery Period Cholinesterase Inhibitors / pharmacology* Electric Stimulation Electromyography Glycopyrrolate / pharmacology* Humans Lung Volume Measurements Male Muscarinic Antagonists / pharmacology* Muscle Contraction / physiology Neostigmine / pharmacology* Neuromuscular Blockade* Neuromuscular Nondepolarizing Agents Pharyngeal Muscles / drug effects* Pharynx / physiology* Plethysmography Respiratory System / drug effects* Tidal Volume / physiology Ulnar Nerve / physiology |
| Chemical | |
Reg. No./Substance:
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0/Androstanols; 0/Cholinesterase Inhibitors; 0/Muscarinic Antagonists; 0/Neuromuscular Nondepolarizing Agents; 143558-00-3/rocuronium; 59-99-4/Neostigmine; 596-51-0/Glycopyrrolate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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