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Korean Journal of Anesthesiology 2000;39(2):232-242.
DOI: https://doi.org/10.4097/kjae.2000.39.2.232   
Effects of Pseudocholinesterase and/or Neostigmine, Pyridostigmine, Edrophonium and Galanthamine for Reversal of Mivacurium- or Succinylcholine-induced Paralysis in Vitro.
Sam Soon Cho, Si Ne Yoon, Yoon Choi, Hong Seuk Yang, Sung Min Han, Sung Youl Kim, Byung Te Suh
1Department of Anesthesiology, Asan Medical Center, College of Medicine, University of Ulsan.
2Department of Anesthesiology, SunChunHyang University Hospital, Seoul, Korea.
The hydrolysis of mivacurium and succinylcholine is impaired in the presence of defects of pseudocholinesterase. Clinical reports are conflicting as to the utility of anticholinesterases, in the reversal of mivacurium- or succinylcholine-induced paralysis. In this study, the role of exogenous bovine pseudocholinesterases (BpChE) and/or neostigmine, pyridostigmine, edrophonium or galanthamine in the reversal of mivacurium- or succinylcholine-induced paralysis, were investigated with the rat phrenic nerve-diaphragm preparation.
Ninety five Sprague-Dawley rats (200 g, male) were divided into 14 groups (n = 10). The phrenic nerve-diaphragm preparation mounted in a bath containing oxygenated Krebs' solution. Twitch response from diaphragmatic muscle evoked by phrenic nerve stimulation were measured. After stabilization of the twitch responses, mivacurium (0.1 microgram/mlml) or succinylcholine (0.1 microgram/ml) was administered incrementally in the preparation to obtain more than 95% twitch inhibition. BpChE (0.1, 1.0 u/ml), and/or neostigmine (0.1, 1.0 microgram/ml), pyridostigmine (0.5, 5 microgram/ml), edrophonium (0.01, 0.1 microgram/ml) or galanthamine (0.1, 1.0 microgram/ml) were added for the reversal of mivacurium- and/or succinylcholine-induced block in each group and the twitch responses (0.1 Hz) were monitored for 60 min. The effect of BpChE (0.1 u/ml), in combination with each of the above four anticholinesterases at lower concentrations also were examined. Twitch heights more than 75% was considered an adequatereversal.
BpChE 0.1 and 1.0 u/ml were effective in reversal of mivacurium-induced paralysis. When anticholinestrases were added, there was no effective improvement of twitch height at the end of 60 minutes. In succinylcholine-induced paralysis, BpChE was effective for reversal, but when anticholinesterases were added, BpChE potency was inhibited. CONCLUSIONS: BpChE will reverse mivacurium-induced block more effectively than anticholinesterase. BpChE is effective in reversing succinylcholine block. The addition of anticholinesterases inhibits the activity of pseudocholinesterase.
Key Words: Antagonist, neuromuscular relaxants: edrphonium, galanthamine, neostigmine, pyridostigmine; Enzyme: pseudocholinesterase; Neuromuscular relaxants: mivacurium, succinylcholine


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