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Duration of Action of Neostigmine and Pyridostigmine in the Elderly

Received from the Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York.

Abstract

This study was undertaken to assess differences between young and elderly patients with respect to the duration of antagonism of metocurine neuromuscular blockade by neostigmine (NEO) or pyridostigmine (PYR). Patients were given either NEO (seven elderly and ten young) or PYR (seven elderly and eight young) and received nitrous oxide in oxygen (60:40) and 1 MAC halothane. Neuromuscular transmission was assessed by using evoked compound electromyography. Metocurine 0.1 mg/kg was given, followed by a continuous infusion to achieve 90% reduction in baseline single twitch height. After at least 30 minutes, either NEO (0.07 mg/kg) or PYR (0.14 mg/kg) and atropine (0.02 mg/kg) were given IV. After injection of NEO or PYX, the duration of maximal response (DOMR) was recorded. Mean (± SE) ages were 38 ± 5 and 68 ± 2 years in the two groups of patients receiving PYX. In the elderly, PYX significantly prolonged DOMR compared to younger patients (35.3 ± 8.2 vs 14.4 ± 4.2 minutes, respectively). The mean ages in the two groups of patients receiving NEO were 41.5 ± 4 and 72 ± 2 years. The elderly group demonstrated a significant increase in the DOMR compared to younger patients (32 ± 10 vs 11 ± 2 minutes, respectively). It is concluded that, compared to younger patients, the duration of action of NEO and PYR in the aged patient is prolonged.

Key Words: NEUROMUSCULAR RELAXANTS—metocurine • ANTAGONISTS, NEUROMUSCULAR RELAXANTS—neostigmine, pyridostigmine • AGE FACTORS—duration of action of relaxant antagonists

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999