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

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
• anticholin-esterase
• postanesthesia care
• postoperative complication

Acknowledgments

This work was supported by the China Scholarship Council (CSC No 201608505030), the National Natural Science Foundation of China (Grant No 81201053) and the Science and Technology Research Program of Chongqing Municipal Education Commission (Grant No KJQN201800419).

Disclosure

The authors report no conflicts of interest in this work.