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Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Authors Luo J, Chen S, Min S, Peng L

Received 7 July 2018

Accepted for publication 17 October 2018

Published 10 December 2018 Volume 2018:14 Pages 2397—2406

DOI https://doi.org/10.2147/TCRM.S179420

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang


Jie Luo, Shuting Chen, Su Min, Lihua Peng

Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Abstract: Postoperative residual neuromuscular block is a serious threat which endangers the patient safety. Neostigmine has been the most commonly used anticholinesterase for the pharmacological reversal of neuromuscular blockade. Although newer agents have been introduced recently, neostigmine has some irreplaceable advantages, including broad-spectrum reversal of all nondepolarizing neuromuscular blocking drugs, low cost, and availability of more related data for clinical practice to refer to. Neostigmine is also noticed to have some drawbacks, such as the inability to reverse profound and deep blockade, potential induction of muscle weakness, cardiovascular adverse effects, and so on. Data on the usage of neostigmine in the geriatric and the pediatric population are still insufficient. Some discrepancies are observed in the results from previous studies which need further investigation. However, recent studies offer some renewed information. Regarding both efficacy and safety, the key for successful reversal of neuromuscular blockade is to use neostigmine “appropriately,” optimizing the dosage and timing of administration under close monitoring.

Keywords: postoperative residual neuromuscular block, neuromuscular reversal, anticholinesterase, postanesthesia care, postoperative complication

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