Document Detail

Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure.
MedLine Citation:
PMID:  20980910     Owner:  NLM     Status:  MEDLINE    
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.
Frank Herbstreit; Daniela Zigrahn; Christof Ochterbeck; Jürgen Peters; Matthias Eikermann
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  113     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1280-8     Citation Subset:  AIM; IM    
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
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MeSH Terms
Air Pressure
Anesthesia Recovery Period
Cholinesterase Inhibitors / pharmacology*
Electric Stimulation
Glycopyrrolate / pharmacology*
Lung Volume Measurements
Muscarinic Antagonists / pharmacology*
Muscle Contraction / physiology
Neostigmine / pharmacology*
Neuromuscular Blockade*
Neuromuscular Nondepolarizing Agents
Pharyngeal Muscles / drug effects*
Pharynx / physiology*
Respiratory System / drug effects*
Tidal Volume / physiology
Ulnar Nerve / physiology
Reg. No./Substance:
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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