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Korean Journal of Anesthesiology 1993;26(6):1143-1147.
DOI: https://doi.org/10.4097/kjae.1993.26.6.1143   
The Reversal Effects of Anticholinergics During Recovery from Vecuronium Induced Neuromuscular Blockade in Humans.
Sung Yell Kim, Kyung Seok Song, Young A Kim, Yong Ik Kim, Si Young Ok, Chun Sook Kim, Sun Chong Kim, Wook Park
Department of Anesthesiology, College of Medicine, Soonchunhyang University, Seoul, Korea.
Abstract
Anticholinergics are commonly used to block undesirable musearinic effects of the anticholinesterase agents. The results observed in man and animal seem indicate that atropine may interfere with the neuromuscular junction. Our study investigate this role in clinical anesthesia, when anticholinergics are given at the beginning of recovery from vecuronium induced neuromuscular blockade. Forty-four ASA I-II adult anesthetized(tbiopental, enflurane, N, vecuronium) patients undergoing elective surgery were monitored with ParaGraph. The patients received intravenously 0.9% normal saline 2ml in control and atropine 0.5mg,atropine 1.0mg, or glycopyrrolate 0.4mg in study group when twitch height spontaneously was beginning to regain. After administration of atropine and glycopyrrolate,TOF ratio and DBS ratio were observed at every 6min intervals. On the other hand, vecumnium 0.8mg in 0.9% normal saline20ml(control) and vecuronium 0.8mg mixed atropine 0.25mg in 0.9% normal saline 20ml(study) were given I.V. each forearm of one patient with double isolation arm test under the normal twitch height. After tourniquet release, first twitch height and TOF ratio were observed at every 5min intervals, All results were no significant different between the control group and those study groups, for all the observed tests, but anticholinergics seem to be shown to enhance the recovery in clinical doses and to delay in large doses from neuromuscular blockade. The mechanism of action of antieholinergics, at the neuromuscular junction, are discussed with references, possibly by acting on muscarinic presynaptic inhibitory receptors, which are invalued in the negative feedback mechanism of transmitter release.
Key Words: Anticholinergics; atropine; glycopyrrolate; Vecuronium; Drug interaction NMT monitoring; TOF ratio; DBS


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