Korean J Anesthesiol.  2000 Aug;39(2):232-242. 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

• Cho SS
• Yoon SN
• Choi Y
• Yang HS
• Han SM
• Kim SY
• Suh BT

• KMID: 2031567
• DOI: http://doi.org/10.4097/kjae.2000.39.2.232

Abstract

BACKGROUND: 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.
METHODS
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.
RESULTS
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.

Keyword

Antagonist, neuromuscular relaxants: edrphonium, galanthamine, neostigmine, pyridostigmine; Enzyme: pseudocholinesterase; Neuromuscular relaxants: mivacurium, succinylcholine

MeSH Terms

Animals
Baths
Cholinesterase Inhibitors
Edrophonium*
Galantamine*
Hydrolysis
Neostigmine*
Oxygen
Paralysis*
Phrenic Nerve
Pseudocholinesterase*
Pyridostigmine Bromide*
Rats
Rats, Sprague-Dawley
Succinylcholine
Cholinesterase Inhibitors
Edrophonium
Galantamine
Neostigmine
Oxygen
Pseudocholinesterase
Pyridostigmine Bromide
Succinylcholine