Optimal dose of neostigmine antagonizing cisatracurium-induced shallow neuromuscular block in elderly patients: a randomized control study

BackgroundResidual neuromuscular block after using neuromuscular blocking agents is a common and potentially harmful complication of general anesthesia. Neostigmine is a widely used antagonist, but its optimal dose for elderly patients is unclear.ObjectivesTo compare the optimal dosage and safety of neostigmine for reversing shallow residual block in elderly patients after cisatracurium-induced neuromuscular block.MethodsA randomized controlled trial was conducted in 196 elderly patients undergoing non-cardiac surgery under general anesthesia with cisatracurium. Patients were assigned to receive either no neostigmine (control group) or neostigmine at 20 & mu;g/kg, 40 & mu;g/kg or 50 & mu;g/kg when train-of-four (TOF) ratio reached 0.2 at the end of surgery. The primary outcome was the time to reach TOF ratio of 0.9 after administration. Secondary outcomes included TOF ratio at 10 min after administration, postoperative nausea and vomiting, postoperative cognitive impairment and post-anesthesia care unit (PACU) stay time.ResultsThe time to reach TOF ratio of 0.9 in the 20 & mu;g/kg, 40 & mu;g/kg and 50 & mu;g/kg groups was significantly shorter than the control group (H = 104.257, P < 0.01), and the time of 40 & mu;g/kg group and 50 & mu;g/kg group was significantly shorter than the 20 & mu;g/kg group (P < 0.001). There was no significant difference between 40 & mu;g/kg and 50 & mu;g/kg groups (P = 0.249). The TOF ratio at 10 min after administration showed similar results. There were no significant differences among groups in postoperative nausea and vomiting, postoperative cognitive impairment or post-operation hospital stay.ConclusionsTimely use of neostigmine after general anesthesia in elderly patients can significantly shorten time of TOF value reaching 0.9, among which 40 & mu;g/kg dosage may be a more optimized choice.