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  • Edrophonium antagonism of cisatracurium-induced neuromuscular block: dose requirements in children and adults.
    Anaesthesia and intensive care, 2001
    Co-Authors: Mohamed Abdulatif, Mohga El-sanabary
    Abstract:

    This randomized, controlled study compared Edrophonium dose requirements to antagonize cisatracurium-induced neuromuscular block in children and adults. Sixty children, aged two to 10 years, and 60 adults aged 20 to 60 years, all subjects ASA physical status 1 or 2, having propofol, fentanyl and isoflurane-N2O anaesthesia, were studied. Cisatracurium 0.1 mg x kg(-1) was given for muscle relaxation. Neuromuscular block was monitored with accelerometry. Edrophonium 0.1, 0.2, 0.4 or 1 mg x kg(-1) or no anticholinesterase (controls) was given by random allocation to antagonize 90% neuromuscular block in each of the study groups (n=12). Atropine 5 to 10 microg x kg(-1) was given according to Edrophonium dose. Onset time of cisatracurium-induced block in children was mean (SD) 2.4 (0.8) versus 4.1 (2.3) minutes in adults, P

  • Edrophonium antagonism of intense mivacurium-induced neuromuscular block in children.
    British journal of anaesthesia, 1996
    Co-Authors: Mohamed Abdulatif, A. Al-ghamdi, M. Al-sanabary, M. E. Abdel-gaffar
    Abstract:

    We have studied the time course of recovery after administration of Edrophonium during intense mivacurium block in children aged 2-10 yr, using thumb acceleration in response to train-of-four (TOF) stimulation. Forty-three children receiving alfentanil, propofol, nitrous oxide, isoflurane anaesthesia and mivacurium 0.2 mg kg-1 were allocated randomly to one of three groups. Patients in group 1 (n = 15) received Edrophonium 1 mg kg-1, 2 min after maximum block (intense block group). At the time of administration of Edrophonium in this group, there was no response to TOF stimulation (100% block) and the post-tetanic count was 10.7 (range 0-20). Patients in group 2 received the same dose of Edrophonium after 10% recovery of the first twitch (T1) in the TOF (conventional reversal). Patients in group 3 (n = 13) recovered spontaneously. All patients developed complete suppression of twitch height in response to the bolus dose of mivacurium. All recovery times were measured from the point of maximum block after mivacurium. Mean time for 25% recovery of T1 (clinical duration) was 3.8 (SD 1.1) min in the intense block group. This was significantly shorter than the conventional reversal (8.3 (2.4) min) and spontaneous recovery (9.2 (3.5) min) groups (P

  • dose response relationships for Edrophonium and neostigmine antagonism of pipecuronium induced neuromuscular block
    Anesthesia & Analgesia, 1994
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif
    Abstract:

    We have studied the dose-response relationships for neostigmine and Edrophonium during antagonism of neuromuscular block induced by pipecuronium bromide. Fifty-six ASA physical status I or II adults were given pipecuronium 70 micrograms/kg during fentanylthiopental-nitrous oxide-halothane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. When spontaneous recovery of first twitch height reached 20% of its initial control value, Edrophonium (0.125, 0.25, 0.75, or 1 mg/kg) or neostigmine (0.015, 0.03, 0.045, or 0.06 mg/kg) was administered by random allocation. Neuromuscular function in another seven subjects was allowed to recover spontaneously. This study demonstrated that the dose-response curves for these two drugs for reversal of first twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% (ED50) and 80% (ED80) recovery of the first twitch after 10 min were 8.5 (7.3-9.7) and 17.4 (16.2-18.7) microgram/kg [mean (95% confidence intervals)], respectively. Corresponding ED50 and ED80 values for endrophonium were 84.1 (72.9-96.9) and 233 (215.7-253.3) microgram/kg, respectively. These values corresponded to neostigmine:Edrophonium potency ratios of 9.89 (7.4-12.3) and 13.4 (11.8-14.9) for first twitch ED50 and ED80 height, respectively. The calculated doses producing 50% (ED50) recovery of the TOF ratio at 10 min were 18.8 (17.5-20.2) and 271.3 (246.5-298.6) microgram/kg for neostigmine and Edrophonium, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

  • dose response relationships for Edrophonium and neostigmine antagonism of rocuronium bromide org 9426 induced neuromuscular blockade
    Anesthesiology, 1993
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif, A Alghamdi
    Abstract:

    Background Rocuronium bromide (ORG 9426) Is a new nondepolarizing muscle relaxant with a rapid onset but an intermediate duration of action. The dose-response relationships for neostigmine and Edrophonium were studied during antagonism of neuromuscular block induced by rocuronium bromide. Methods Sixty-four ASA physical status 1 or 2 adults were given 0.6 mg/kg rocuronium bromide during thiopental-fentanyl-nitrous oxide-isoilurane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. When spontaneous recovery of first twitch height reached 10% of its initial control value, Edrophonium (0.1, 0.2, 0.4, or 1 mg/kg) or neostigmine (0.005, 0.01, 0.02, or 0.05 mg/kg) was administered by random allocation. Neuromuscular function in another eight subjects was allowed to recover spontaneously. Assisted recovery was defined as actual recovery minus mean spontaneous recovery in patients who were not given antagonists. Results The dose-response curves for neostigmine- and Edrophonium-assisted antagonism of rocuronium bromide neuromuscular blockade for the single twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% and 80% recovery (ED50 and ED80, respectively) of the first twitch after 10 min were 0.017 (0.001) and 0.033 (0.001) mg/kg (mean (standard error of estimate for the mean)), respectively. Corresponding ED50 and ED80 values for Edrophonium were 0.161 (0.001) and 0.690 (0.001) mg/kg, respectively. These values corresponded to neostigmine:Edrophonium potency ratios of 9.5 (0.56) and 21 (0.67) for first twitch ED50 and ED80 height, respectively. The calculated doses producing ED50 of the TOF ratio at 10 min were 0.017 (0.001) and 0.469 (0.001) mg/kg for neostigmine and Edrophonium, respectively. These values corresponded to a potency ratio of 27.5 (1.66). Conclusions Under the conditions described in this study, if reversal was attempted at 10% first twitch recovery, Edrophonium was less capable than neostigmine of reversing fade (potency ratio of 19.2 and 27.5 at 5 and 10 min, respectively) than first twitch (potency ratio of 6.7 and 9.5 at 5 and 10 min, respectively) during antagonism of rocuronium bromide-induced blockade. Edrophonium was found to be less effective than neostigmine at reversing rocuronium bromide-induced TOF fade.

  • Edrophonium priming alters the course of neuromuscular recovery from a pipecuronium neuromuscular blockade.
    Canadian journal of anaesthesia = Journal canadien d'anesthesie, 1991
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif
    Abstract:

    This study was designed to investigate the effect of divided administration of Edrophonium on the course of neuromuscular recovery from a pipecuronium neuromuscular blockade. During thiopentone-nitrous oxide-halothane anaesthesia 48 patients were given pipecuronium 70 μg · kg−1. Patients were randomly assigned to one of four groups (n = 12 in each) to receive either Edrophonium 1 mg · kg−1 (Groups I and II) or Edrophonium 0.75 mg · kg−1 (Groups III and IV). In Groups I and III (single-dose groups), Edrophonium was administered as a single bolus dose. In Groups II and IV (divided-dose groups) Edrophonium was administered as an initial dose of 0.25 mg · kg−1 followed three minutes later by either 0.75 or 0.50 mg · kg−1 respectively. Reversal was attempted at 20% spontaneous recovery of twitch height. Administration of Edrophonium in divided doses (Groups II and IV) accelerated the reversal of the pipecuronium neuromuscular blockade. At ten minutes post-reversal, train-of-four (TOF) ratio recovery reached 0.75 or more in 12 (100%) and in ten (83%) patients in Groups II and IV respectively. Similarly, times to attain a TOF of 0.75 (SEM) were shorter in the divided-dose groups than in the single-dose groups (P < 0.05), being 354.5 (38.7) and 398.3 (49.1) sec in Groups II and IV vs 705.4 (66.6) and 651.2 (54.3) sec in Groups I and III respectively. Time was counted from the first administration of Edrophonium. It is concluded that administration of Edrophonium in divided doses produced a faster reversal of residual pipecuronium-induced neuromuscular blockade than single bolus administration. Also, administration in divided doses reduced the requirements of Edrophonium needed for reversal of pipecuronium neuromuscular blockade.

Mohamed Naguib - One of the best experts on this subject based on the ideXlab platform.

  • dose response relationships for Edrophonium and neostigmine antagonism of pipecuronium induced neuromuscular block
    Anesthesia & Analgesia, 1994
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif
    Abstract:

    We have studied the dose-response relationships for neostigmine and Edrophonium during antagonism of neuromuscular block induced by pipecuronium bromide. Fifty-six ASA physical status I or II adults were given pipecuronium 70 micrograms/kg during fentanylthiopental-nitrous oxide-halothane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. When spontaneous recovery of first twitch height reached 20% of its initial control value, Edrophonium (0.125, 0.25, 0.75, or 1 mg/kg) or neostigmine (0.015, 0.03, 0.045, or 0.06 mg/kg) was administered by random allocation. Neuromuscular function in another seven subjects was allowed to recover spontaneously. This study demonstrated that the dose-response curves for these two drugs for reversal of first twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% (ED50) and 80% (ED80) recovery of the first twitch after 10 min were 8.5 (7.3-9.7) and 17.4 (16.2-18.7) microgram/kg [mean (95% confidence intervals)], respectively. Corresponding ED50 and ED80 values for endrophonium were 84.1 (72.9-96.9) and 233 (215.7-253.3) microgram/kg, respectively. These values corresponded to neostigmine:Edrophonium potency ratios of 9.89 (7.4-12.3) and 13.4 (11.8-14.9) for first twitch ED50 and ED80 height, respectively. The calculated doses producing 50% (ED50) recovery of the TOF ratio at 10 min were 18.8 (17.5-20.2) and 271.3 (246.5-298.6) microgram/kg for neostigmine and Edrophonium, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

  • dose response relationships for Edrophonium and neostigmine antagonism of rocuronium bromide org 9426 induced neuromuscular blockade
    Anesthesiology, 1993
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif, A Alghamdi
    Abstract:

    Background Rocuronium bromide (ORG 9426) Is a new nondepolarizing muscle relaxant with a rapid onset but an intermediate duration of action. The dose-response relationships for neostigmine and Edrophonium were studied during antagonism of neuromuscular block induced by rocuronium bromide. Methods Sixty-four ASA physical status 1 or 2 adults were given 0.6 mg/kg rocuronium bromide during thiopental-fentanyl-nitrous oxide-isoilurane anesthesia. Train-of-four (TOF) stimulation was applied to the ulnar nerve every 10 s, and the force of contraction of the adductor pollicis muscle was recorded. When spontaneous recovery of first twitch height reached 10% of its initial control value, Edrophonium (0.1, 0.2, 0.4, or 1 mg/kg) or neostigmine (0.005, 0.01, 0.02, or 0.05 mg/kg) was administered by random allocation. Neuromuscular function in another eight subjects was allowed to recover spontaneously. Assisted recovery was defined as actual recovery minus mean spontaneous recovery in patients who were not given antagonists. Results The dose-response curves for neostigmine- and Edrophonium-assisted antagonism of rocuronium bromide neuromuscular blockade for the single twitch and TOF ratio were not parallel. The doses of neostigmine required to achieve 50% and 80% recovery (ED50 and ED80, respectively) of the first twitch after 10 min were 0.017 (0.001) and 0.033 (0.001) mg/kg (mean (standard error of estimate for the mean)), respectively. Corresponding ED50 and ED80 values for Edrophonium were 0.161 (0.001) and 0.690 (0.001) mg/kg, respectively. These values corresponded to neostigmine:Edrophonium potency ratios of 9.5 (0.56) and 21 (0.67) for first twitch ED50 and ED80 height, respectively. The calculated doses producing ED50 of the TOF ratio at 10 min were 0.017 (0.001) and 0.469 (0.001) mg/kg for neostigmine and Edrophonium, respectively. These values corresponded to a potency ratio of 27.5 (1.66). Conclusions Under the conditions described in this study, if reversal was attempted at 10% first twitch recovery, Edrophonium was less capable than neostigmine of reversing fade (potency ratio of 19.2 and 27.5 at 5 and 10 min, respectively) than first twitch (potency ratio of 6.7 and 9.5 at 5 and 10 min, respectively) during antagonism of rocuronium bromide-induced blockade. Edrophonium was found to be less effective than neostigmine at reversing rocuronium bromide-induced TOF fade.

  • Edrophonium priming alters the course of neuromuscular recovery from a pipecuronium neuromuscular blockade.
    Canadian journal of anaesthesia = Journal canadien d'anesthesie, 1991
    Co-Authors: Mohamed Naguib, Mohamed Abdulatif
    Abstract:

    This study was designed to investigate the effect of divided administration of Edrophonium on the course of neuromuscular recovery from a pipecuronium neuromuscular blockade. During thiopentone-nitrous oxide-halothane anaesthesia 48 patients were given pipecuronium 70 μg · kg−1. Patients were randomly assigned to one of four groups (n = 12 in each) to receive either Edrophonium 1 mg · kg−1 (Groups I and II) or Edrophonium 0.75 mg · kg−1 (Groups III and IV). In Groups I and III (single-dose groups), Edrophonium was administered as a single bolus dose. In Groups II and IV (divided-dose groups) Edrophonium was administered as an initial dose of 0.25 mg · kg−1 followed three minutes later by either 0.75 or 0.50 mg · kg−1 respectively. Reversal was attempted at 20% spontaneous recovery of twitch height. Administration of Edrophonium in divided doses (Groups II and IV) accelerated the reversal of the pipecuronium neuromuscular blockade. At ten minutes post-reversal, train-of-four (TOF) ratio recovery reached 0.75 or more in 12 (100%) and in ten (83%) patients in Groups II and IV respectively. Similarly, times to attain a TOF of 0.75 (SEM) were shorter in the divided-dose groups than in the single-dose groups (P < 0.05), being 354.5 (38.7) and 398.3 (49.1) sec in Groups II and IV vs 705.4 (66.6) and 651.2 (54.3) sec in Groups I and III respectively. Time was counted from the first administration of Edrophonium. It is concluded that administration of Edrophonium in divided doses produced a faster reversal of residual pipecuronium-induced neuromuscular blockade than single bolus administration. Also, administration in divided doses reduced the requirements of Edrophonium needed for reversal of pipecuronium neuromuscular blockade.

  • Neostigmine and Edrophonium for reversal of pipecuronium neuromuscular blockade.
    Canadian journal of anaesthesia = Journal canadien d'anesthesie, 1991
    Co-Authors: Mohamed Abdulatif, Mohamed Naguib
    Abstract:

    Neostigmine 0.06 mg · kg−1 or Edrophonium 1 mg · kg−1 were administered to two groups of 15 patients each for antagonism of pipecuronium-induced neuromuscular block at 20% spontaneous recovery of the first twitch (T1) of the train-of-four (TOF) stimulation. The mean onset of action (± SEM) of Edrophonium (18.1 ± 2.4 sec) was significantly more rapid (P < 0.01) than that of neostigmine (47.6 ± 4 sec), as were the times taken to attain a TOF ratio of 0.25 and 0.5. Nevertheless, the reversal time (time taken from the end of injection of the antagonist until TOF ratio value had reached 0.75) was significantly shorter (P < 0.01) in the neostigmine than in the Edrophonium group (499.3 ± 62 vs 767 ± 52 sec respectively). The TOF ratio ten minutes after reversal was greater in the neostigmine group than in the Edrophonium group (P < 0.01), 0.78 ± 0.02 vs 0.68 ± 0.02 min respectively. At that time, 33% (5 out of 15) and 80% (12 out of 15) patients failed to be reversed adequately (TOF ratio of 0.75) after neostigmine 0.06 mg · kg−1 and Edrophonium 1 mg · kg−1, respectively. Administration of one additional dose (one-third of the initial dose) of the same antagonist resulted in adequate antagonism in the remaining five patients in the neostigmine group and in nine patients in the Edrophonium group. Two such doses were required in the remaining three patients in the latter group. The mean total dose of neostigmine and Edrophonium employed in this study was 0.067 ± 0.002 and 1.3 ± 0.05 mg · kg−1, respectively. Under the conditions of this study, Edrophonium in a dose of 1 mg · kg−1 did not consistently antagonize residual neuromuscular blockade induced by pipecuronium at 20% recovery of T1.

Keith G. Lurie - One of the best experts on this subject based on the ideXlab platform.

  • comparison of tilt angles and provocative agents Edrophonium and isoproterenol to improve head upright tilt table testing
    American Journal of Cardiology, 1998
    Co-Authors: Ronald A Voice, Keith G. Lurie, Scott Sakaguchi, Thomes S Rector, David G Benditt
    Abstract:

    Patients with syncope underwent head-up tilt testing at 60 degrees and 80 degrees followed by Edrophonium or isoproterenol challenge when indicated. The 80 degrees tilt protocol and Edrophonium provocation were found to be as effective or more effective in eliciting neurally mediated syncope in susceptible patients.

  • Evaluation of Edrophonium as a provocative agent for vasovagal syncope during head-up tilt-table testing.
    The American journal of cardiology, 1993
    Co-Authors: Keith G. Lurie, J. Dutton, Ripdeep Mangat, David Newman, Susan J. Eisenberg, Melvin M. Scheinman
    Abstract:

    Abstract Vasovagal syncope after head-up tilting is thought to be secondary to a complex, neurally-mediated reflex with both vasodepressor and cardioinhibitory efferent components. The efficacy of Edrophonium, an acetylcholinesterase inhibitor, as a provocative agent for triggering syncope during head-up tilt testing was evaluated. Forty-five consecutive patients (22 female and 23 male) with history of recurrent unexplained syncope received Edrophonium (10 mg intravenous) after 30 minutes of 60 ° head-up tilting atone. Twenty normal control subjects (9 female and 11 male) were tested with head-up tilt testing and Edrophonium. Syncope was induced in 19 of 45 patients with the diagnosis of unexplained syncope. In 9 patients who developed syncope with head-up tilting alone, the predominant hemodynamic finding was marked vasodepression. In contrast, in 10 patients who developed syncope only after head-up tilting and Edrophonium, the predominant hemodynamic findings were marked vasodepression and bradycardia. Syncope was induced in 1 of 20 normal subjects after head-up tilting and Edrophonium. There was no long-term complication from using Edrophonium. It is concluded that head-up tilt testing with Edrophonium: (1) significantly increases the identification of patients with vasovagal syncope, (2) may be particularly useful when provocation with isoproterenol is undesirable, and (3) may be an effective method to help differentiate patients with a significant reflex cardioinhibitory component from those with a predominantly reflex vasodepressor component.

David G Benditt - One of the best experts on this subject based on the ideXlab platform.

Melvin M. Scheinman - One of the best experts on this subject based on the ideXlab platform.

  • Evaluation of Edrophonium as a provocative agent for vasovagal syncope during head-up tilt-table testing.
    The American journal of cardiology, 1993
    Co-Authors: Keith G. Lurie, J. Dutton, Ripdeep Mangat, David Newman, Susan J. Eisenberg, Melvin M. Scheinman
    Abstract:

    Abstract Vasovagal syncope after head-up tilting is thought to be secondary to a complex, neurally-mediated reflex with both vasodepressor and cardioinhibitory efferent components. The efficacy of Edrophonium, an acetylcholinesterase inhibitor, as a provocative agent for triggering syncope during head-up tilt testing was evaluated. Forty-five consecutive patients (22 female and 23 male) with history of recurrent unexplained syncope received Edrophonium (10 mg intravenous) after 30 minutes of 60 ° head-up tilting atone. Twenty normal control subjects (9 female and 11 male) were tested with head-up tilt testing and Edrophonium. Syncope was induced in 19 of 45 patients with the diagnosis of unexplained syncope. In 9 patients who developed syncope with head-up tilting alone, the predominant hemodynamic finding was marked vasodepression. In contrast, in 10 patients who developed syncope only after head-up tilting and Edrophonium, the predominant hemodynamic findings were marked vasodepression and bradycardia. Syncope was induced in 1 of 20 normal subjects after head-up tilting and Edrophonium. There was no long-term complication from using Edrophonium. It is concluded that head-up tilt testing with Edrophonium: (1) significantly increases the identification of patients with vasovagal syncope, (2) may be particularly useful when provocation with isoproterenol is undesirable, and (3) may be an effective method to help differentiate patients with a significant reflex cardioinhibitory component from those with a predominantly reflex vasodepressor component.