ASSESSMENT OF DIFFERENT DOSES OF NEOSTIGMINE IN REVERSING CISATRACURIUM INDUCED NEUROMUSCULAR BLOCK BY USING NEUROMUSCULAR MONITOR: A PROSPECTIVE, DOUBLE-BLIND RANDOMIZED TRIAL

Abstract

Objective: This study aimed to evaluate the effectiveness of different reversal strategies with neostigmine in cisatracurium-induced neuromuscular blockade by, focusing on recovery times, incidence of residual blockade, and patient safety profile. Methods: A prospective, randomized, double-blind trial was conducted involving six groups of patients (n=30 each) receiving different dosages of neostigmine at different TOF ratios. Neuromuscular function recovery, residual blockade incidence, and safety were assessed using various measurements. Statistical analysis included ANOVA, Chi-square tests, and post-hoc analyses. Results: The study found that recovery times varied based on neostigmine dosages and train-of-four (TOF) ratios at the time of administration. The study groups exhibited varying mean times to achieve TOF ratios of 0.9 and 1.0 after neostigmine administration. The incidence of post-extubation TOF ratios below 0.9 showed no substantial variation among the groups. The overall incidence of adverse effects was low, with no significant differences observed among the study groups. Conclusion: The study concludes that 30 mcg/kg administered at TOF ratio 0.6 may be the most effective dosage of neostigmine for rapid and sufficient recovery from shallow neuromuscular blockade at TOF ratio 0.4 or 0.6, with the fewest adverse effects. 20 mcg/kg is the lowest dose that can be used to successfully restore shallow neuromuscular block, albeit it does take longer time.