Neostigmine in Clinical Practice
Question: Neostigmine acts at all sites where AChE is present and this includes the heart. What effect might this have?
Question: Neostigmine acts at all sites where AChE is present and this includes the heart. What effect might this have?
Answer: Bradycardia.
Question: How might this be overcome?
Question: Neostigmine acts at all sites where AChE is present and this includes the heart. What effect might this have?
Answer: Bradycardia.
Question: How might this be overcome?
Answer: Give an anticholinergic, such as glycopyrrolate or atropine, with neostigmine.
Question: The recommended dose of neostigmine is 0.05 mg/kg. It is presented in a 1 ml ampoule of 2.5 mg alone or premixed with glycopyrrolate 0.5 mg. What is the maximum size of patient for which one ampoule adequately reverses neuromuscular blockade?
Question: Neostigmine acts at all sites where AChE is present and this includes the heart. What effect might this have?
Answer: Bradycardia.
Question: How might this be overcome?
Answer: Give an anticholinergic, such as glycopyrrolate or atropine, with neostigmine.
Question: The recommended dose of neostigmine is 0.05 mg/kg. It is presented in a 1 ml ampoule of 2.5 mg alone or premixed with glycopyrrolate 0.5 mg. What is the maximum size of patient for which one ampoule adequately reverses neuromuscular blockade?
Answer: 50 kg.
Most adult patients weigh more than 50 kg so more than 2.5 mg may be indicated. If the PNS indicates that the neuromuscular blockade has nearly worn off, 2.5 mg for a 75 kg patient is often sufficient. Following reversal the PNS indicates the adequacy of the reversal dose.