The influence of mild hypothermia on the pharmacokinetics and time course of action of neostigmine in anesthetized volunteers

Background The pharmacokinetics, maximum effect, and time course of action of neostigmine were studied in seven human volunteers. Methods: Each volunteer was studied twice, during both normothermia and hypothermia. Anesthesia was induced with 30 mug/kg alfentanil and 3 mg/kg propofol, and was maintained with 60-70% nitrous oxide and 0.7-0.9% isoflurane. The mechanical response of the adductor pollicis to train-of-four stimulation of the ulnar nerve was recorded, and central body temperature maintained stable at either less than 34.5degreesC or greater than 36.5degreesC by surface cooling or warming. Before neostigmine administration, a stable 5% twitch height was obtained by an infusion of vecuronium, and the infusion rate remained unchanged thereafter. Neostigmine, 70 mug/kg, was then infused over 2 min, and blood samples for estimation of neostigmine concentrations were collected at intervals for 240 min. Results: With hypothermia, the central volume of distribution of neostigmine decreased by 38%, and onset time of maximum effect increased 0.6 vs. 5.6 min). Hypothermia did not change the clearance (696 ml/min), maximum effect, or duration of action of neostigmine. Conclusions: The efficacy of neostigmine as an antagonist of vecuronium-induced neuromuscular block is not altered by mild hypothermia.