EFFECT OF ANTAGONISM OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK ON POSTOPERATIVE EMESIS IN CHILDREN

The routine use of cholinesterase inhibitors to antagonize residual ne uromuscular block may be associated with increased postoperative emesi s. Rapid spontaneous recovery from mivacurium may obviate the need for these drugs. In this randomized, double-blind, placebo-controlled stu dy of 113 healthy children who had received mivacurium as part of a st andardized anesthetic regimen, we compared the incidence of postoperat ive complications after spontaneous recovery and after the use of neos tigmine-glycopyrrolate or edrophonium-atropine. The anesthetic regimen consisted of halothane, nitrous oxide, fentanyl, 2 mu g/kg intravenou s (IV), mivacurium in an initial dose of 0.2 mg/kg, followed by an inf usion, adjusted to maintain greater than or equal to 1 evoked contract ion response to a supramaximum train-of-four stimulus. At the end of t he procedure, patients received by random assignment one of three drug combinations: 1) neostigmine 70 mu g/kg + glycopyrrolate 10 mu g/kg, IV, 2) edrophonium 1 mg/kg + atropine 10 mu g/kg, IV, and 3) saline. T he trachea was extubated when evoked responses to peripheral nerve sti mulation and clinical signs of adequate neuromuscular recovery were pr esent. Postoperative pain was treated with morphine and emesis with me toclopramide. There were no significant differences between the three groups with respect to age, surgery, intraoperative fentanyl, and miva curium use, time from the end of surgery to tracheal extubation, posta nesthesia care unit (PACU) arrival and discharge, or in postoperative oxygen saturation values and analgesic requirements. Compared to the p lacebo group, emesis occurred more often in the PACU in patients recei ving the neostigmine-glycopyrrolate combination, but not after edropho nium-atropine. However, after discharge from the PACU, emesis rates we re similar in the three study groups. We conclude that spontaneous rec overy or reversal with edrophonium from a moderate degree of mivacuriu m-induced block may offer advantages over the use of neostigmine, with out increasing time to PACU arrival.