Comparision of Different Dose of Neostigmine at Advanced Decurarization

Phase 3

Completed

Brief Summary: Neuromuscular blockers (NMB) are currently used in anesthesia. Residual paralysis (RP) due to NMB is responsible for respiratory disorders after extubation. Neuromuscular blockade is monitored by train-of-four (TOF) stimulation at the adductor pollicis. To exclude a RP a mechanomyographic TOF ratio of 0.9 is mandatory. But mecanomyography is not available in clinical routine. Acceleromyography is the most currently monitoring available in daily practice but it has been proved that an acceloromyographic (AMG) TOF ratio of 1.0 is necessary to exclude a RP. The incidence of RP in recovery room is underestimated. So to perform a safe extubation, reversal of the neuromuscular blockade is necessary when an AMG TOF ratio has not reached 1.0. Reversal of neuromuscular blockade is achieved with neostigmine. The recommended dose is 0.04 mg/kg. The administration of neostigmine causes parasympathomimetic effects which has to be reversed with atropine. When neuromuscular blockade is light (AMG TOF ratio of 0.4 which corresponds to the absence of fade at the visual evaluation of the TOF), a low dose of neostigmine might be sufficient with less side effects expected. The goal of the study is to compare the delay between a light neuromuscular block and an AMG TOF ratio of 1.0 for three neostigmine regimens of neostigmine 0.04, 0.02, 0.01 mg/kg with atropine respectively 0.02, 0.01, 0.005 mg/kg and a placebo.

Recruitment & Eligibility

Inclusion Criteria

patient > 18 years
informed consent signed
Patient undergoing any type of scheduled surgery under general anesthesia for which curarization with eventually a maintenance is indicated
ASA score between I to III

Exclusion Criteria

patient > 75 years and < 18 years
body mass index > 32 mg/m²
neurology disease, neuromuscular or muscular disease
peripheral neuropathy
coronary heart disease
asthma
familial history of malign hyperthermia
difficulty of intubation and ventilation
full stomach
known or suspected allergy to one of the study drug
mecanique obstruction of digestive or urinary tract
open-angle glaucoma
patient with risk of urinary retention linked to urethra-prostatic disorder
concomittant medication with a influence known on neuromuscular (aminosid, anti-convulsif and corticosteroid
child bearing women or nursing mother
no affiliation at a social security

Arm && Interventions

Group	Intervention	Description
1	neostigmine	neostigmine 0.04 mg.kg associated with atropine 0.02 mg/kg
2	neostigmine	neostigmine 0.02 mg.kg associated with atropine 0.01 mg/kg
3	neostigmine	neostigmine 0.1 mg.kg associated with atropine 0.05 mg/kg

Primary Outcome Measures

Name	Time	Method
Mesure of the Train-of-four (TOF)	from neostigmine injection to TOF ratio = 0.9 and 1.0, evaluated every minute up to 1 hour	train-of-four monitoring (also known as neuromuscular monitoring), is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function, by recording muscle response after nerves electrical stimulation.

Secondary Outcome Measures