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What are the ED50 and ED95 doses of atropine required to prevent bradycardia when mixed with different doses of edrophonium for antagonism of pancuronium-induced neuromuscular blockade?
What are the ED50 and ED95 doses of atropine required to prevent bradycardia when mixed with different doses of edrophonium for antagonism of pancuronium-induced neuromuscular blockade?
Higher doses of edrophonium require proportionally higher doses of atropine to prevent bradycardia during reversal of neuromuscular blockade.
Clinicians should titrate atropine higher with larger edrophonium doses to avoid bradycardia; extends quantitative dosing data for neuromuscular reversal.
The dose-response and the doses required to prevent bradycardia in 50% (ED50) and 95% (ED95) of patients were determined for atropine after antagonism of pancuronium-induced neuromuscular blockade in 72 patients with edrophonium-atropine mixtures. Edrophonium 0.67 mg/kg (group A, n = 37) or 1.0 mg/kg (group B, n = 35) was randomly mixed with one of seven doses of atropine (ranging from 0.0125 to 0.0215 mg/kg in group A and from 0.02 to 0.04 mg/kg in group B); with dose-response curves for atropine being constructed for both groups 5 and 10 minutes after the injection of the mixture. These dose-response curves were found to be parallel in both groups. The calculated ED50 values of atropine were 1.6-2 times greater in group B, compared with those in group A. The estimated ED50 doses of atropine in groups A and B at 5 minutes were 0.018 and 0.029 mg/kg, respectively, and at 10 minutes, the ED50 doses were similar, being 0.016 and 0.032 mg/kg, respectively. The calculated ED95 doses of atropine in groups A and B at 5 minutes were 0.024 and 0.055 mg/kg, and at 10 minutes, the ED95 doses were also similar, being 0.027 and 0.05 mg/kg, respectively.
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Naguib et al. (1988) studied this question.
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