Factors Affecting Reversal

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Factors Affecting Reversal
Several factors modify the rate of recovery of neuromuscular activity after reversal. Intensity of Block The more intense the block at the time of reversal, the neostigmine is more effective than edrophonium or pyridostigmine in antagonizing intense (90%) blockade. Age Recovery of neuromuscular activity occurs more rapidly with smaller doses of anticholinesterases in infants and children than in Although the elimination of anticholinesterases is reduced in this age group, this is counterbalanced by the tendency for neuromuscular blockade to wear off more slowly. This is especially true of steroid neuromuscular blocking agents, such as vecuronium and rocuronium, which have a slower recovery index in the elderly. Drugs that potentiate neuromuscular blockade can slow reversal or produce recurarization if given after anticholinesterase administration. Halogenated agents, when continued after neostigmine administration, prolong time to full reversal. aminoglycoside antibiotics or magnesium must be given shortly after reversal agents.117 Renal Failure Anticholinesterases are actively secreted into the tubular lumen so that their clearance is reduced in renal failure.153 Thus, duration of action of neostigmine and edrophonium is increased in renal failure, Anticholinesterases: Other Effects Cardiovascular Anticholinesterases provoke profound vagal stimulation. The time course of the vagal effects parallels the reversal of block: rapid for edrophonium and slower for neostigmine Atropine has a rapid onset of action (1 minute), duration of 30 to 60 minutes,makes it appropriate for use in combination with edrophonium,159 whereas glycopyrrolate (onset 2 to 3 minutes) is more suitable with neostigmine or pyridostigmine

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