Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function

Matthias Eikermann, Philipp Fassbender, Atul Malhotra, Masaya Takahashi, Shigeto Kubo, Amy S. Jordan, Shiva Gautam, David P. White, Nancy L. Chamberlin

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

BACKGROUND: It is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present. The authors hypothesized that cholinesterase inhibition when given the in absence of neuromuscular blockade (NB) would decrease upper airway dilatory muscle activity and consequently upper airway volume. METHODS: The authors measured genioglossus and diaphragm electromyograms during spontaneous ventilation in anesthetized, tracheostomized rats before and after administration of neostigmine (0.03, 0.06, or 0.12 mg/kg), after recovery of the train-of-four ratio (quadriceps femoris muscle) to unity after NB (n = 18). For comparison, the authors made the same measurements in rats that had no previous NB (n = 27). In intact anesthetized rats, the authors measured upper airway volume and end-expiratory lung volume by magnetic resonance imaging before and after 0.12 mg/kg neostigmine (n = 9). RESULTS: Neostigmine treatment in rats that had fully recovered from NB based on the train-of-four ratio caused dose-dependent decreases in genioglossus electromyogram (to 70.3 ± 7.6, 49.2 ± 3.2, and 39.7 ± 2.3% of control, respectively), decreases in diaphragm electromyogram (to 103.1 ± 6.5, 83.1 ± 4.7, and 68.7 ± 7.3% of control), and decreases in minute ventilation to a nadir value of 79.6 ± 6% of preneostigmine baseline. Genioglossus electromyogram effects were the same when neostigmine was given with no previous NB. Neostigmine caused a decrease in upper airway volume to 83 ± 3% of control, whereas end-expiratory lung volume remained constant. CONCLUSIONS: The cholinesterase inhibitor neostigmine markedly impairs upper airway dilator volume, genioglossus muscle function, diaphragmatic function, and breathing when given after recovery from vecuronium-induced neuromuscular block.

Original languageEnglish (US)
Pages (from-to)621-629
Number of pages9
JournalAnesthesiology
Volume107
Issue number4
DOIs
StatePublished - Oct 2007

Fingerprint

Neostigmine
Cholinesterase Inhibitors
Neuromuscular Blockade
Diaphragm
Muscles
Electromyography
Quadriceps Muscle
Ventilation
Neuromuscular Blocking Agents
Vecuronium Bromide
Lung
Cholinesterases
Respiration
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. / Eikermann, Matthias; Fassbender, Philipp; Malhotra, Atul; Takahashi, Masaya; Kubo, Shigeto; Jordan, Amy S.; Gautam, Shiva; White, David P.; Chamberlin, Nancy L.

In: Anesthesiology, Vol. 107, No. 4, 10.2007, p. 621-629.

Research output: Contribution to journalArticle

Eikermann, M, Fassbender, P, Malhotra, A, Takahashi, M, Kubo, S, Jordan, AS, Gautam, S, White, DP & Chamberlin, NL 2007, 'Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function', Anesthesiology, vol. 107, no. 4, pp. 621-629. https://doi.org/10.1097/01.anes.0000281928.88997.95
Eikermann, Matthias ; Fassbender, Philipp ; Malhotra, Atul ; Takahashi, Masaya ; Kubo, Shigeto ; Jordan, Amy S. ; Gautam, Shiva ; White, David P. ; Chamberlin, Nancy L. / Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. In: Anesthesiology. 2007 ; Vol. 107, No. 4. pp. 621-629.
@article{21035629bc7c4551817e2dbb57318069,
title = "Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function",
abstract = "BACKGROUND: It is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present. The authors hypothesized that cholinesterase inhibition when given the in absence of neuromuscular blockade (NB) would decrease upper airway dilatory muscle activity and consequently upper airway volume. METHODS: The authors measured genioglossus and diaphragm electromyograms during spontaneous ventilation in anesthetized, tracheostomized rats before and after administration of neostigmine (0.03, 0.06, or 0.12 mg/kg), after recovery of the train-of-four ratio (quadriceps femoris muscle) to unity after NB (n = 18). For comparison, the authors made the same measurements in rats that had no previous NB (n = 27). In intact anesthetized rats, the authors measured upper airway volume and end-expiratory lung volume by magnetic resonance imaging before and after 0.12 mg/kg neostigmine (n = 9). RESULTS: Neostigmine treatment in rats that had fully recovered from NB based on the train-of-four ratio caused dose-dependent decreases in genioglossus electromyogram (to 70.3 ± 7.6, 49.2 ± 3.2, and 39.7 ± 2.3{\%} of control, respectively), decreases in diaphragm electromyogram (to 103.1 ± 6.5, 83.1 ± 4.7, and 68.7 ± 7.3{\%} of control), and decreases in minute ventilation to a nadir value of 79.6 ± 6{\%} of preneostigmine baseline. Genioglossus electromyogram effects were the same when neostigmine was given with no previous NB. Neostigmine caused a decrease in upper airway volume to 83 ± 3{\%} of control, whereas end-expiratory lung volume remained constant. CONCLUSIONS: The cholinesterase inhibitor neostigmine markedly impairs upper airway dilator volume, genioglossus muscle function, diaphragmatic function, and breathing when given after recovery from vecuronium-induced neuromuscular block.",
author = "Matthias Eikermann and Philipp Fassbender and Atul Malhotra and Masaya Takahashi and Shigeto Kubo and Jordan, {Amy S.} and Shiva Gautam and White, {David P.} and Chamberlin, {Nancy L.}",
year = "2007",
month = "10",
doi = "10.1097/01.anes.0000281928.88997.95",
language = "English (US)",
volume = "107",
pages = "621--629",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function

AU - Eikermann, Matthias

AU - Fassbender, Philipp

AU - Malhotra, Atul

AU - Takahashi, Masaya

AU - Kubo, Shigeto

AU - Jordan, Amy S.

AU - Gautam, Shiva

AU - White, David P.

AU - Chamberlin, Nancy L.

PY - 2007/10

Y1 - 2007/10

N2 - BACKGROUND: It is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present. The authors hypothesized that cholinesterase inhibition when given the in absence of neuromuscular blockade (NB) would decrease upper airway dilatory muscle activity and consequently upper airway volume. METHODS: The authors measured genioglossus and diaphragm electromyograms during spontaneous ventilation in anesthetized, tracheostomized rats before and after administration of neostigmine (0.03, 0.06, or 0.12 mg/kg), after recovery of the train-of-four ratio (quadriceps femoris muscle) to unity after NB (n = 18). For comparison, the authors made the same measurements in rats that had no previous NB (n = 27). In intact anesthetized rats, the authors measured upper airway volume and end-expiratory lung volume by magnetic resonance imaging before and after 0.12 mg/kg neostigmine (n = 9). RESULTS: Neostigmine treatment in rats that had fully recovered from NB based on the train-of-four ratio caused dose-dependent decreases in genioglossus electromyogram (to 70.3 ± 7.6, 49.2 ± 3.2, and 39.7 ± 2.3% of control, respectively), decreases in diaphragm electromyogram (to 103.1 ± 6.5, 83.1 ± 4.7, and 68.7 ± 7.3% of control), and decreases in minute ventilation to a nadir value of 79.6 ± 6% of preneostigmine baseline. Genioglossus electromyogram effects were the same when neostigmine was given with no previous NB. Neostigmine caused a decrease in upper airway volume to 83 ± 3% of control, whereas end-expiratory lung volume remained constant. CONCLUSIONS: The cholinesterase inhibitor neostigmine markedly impairs upper airway dilator volume, genioglossus muscle function, diaphragmatic function, and breathing when given after recovery from vecuronium-induced neuromuscular block.

AB - BACKGROUND: It is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present. The authors hypothesized that cholinesterase inhibition when given the in absence of neuromuscular blockade (NB) would decrease upper airway dilatory muscle activity and consequently upper airway volume. METHODS: The authors measured genioglossus and diaphragm electromyograms during spontaneous ventilation in anesthetized, tracheostomized rats before and after administration of neostigmine (0.03, 0.06, or 0.12 mg/kg), after recovery of the train-of-four ratio (quadriceps femoris muscle) to unity after NB (n = 18). For comparison, the authors made the same measurements in rats that had no previous NB (n = 27). In intact anesthetized rats, the authors measured upper airway volume and end-expiratory lung volume by magnetic resonance imaging before and after 0.12 mg/kg neostigmine (n = 9). RESULTS: Neostigmine treatment in rats that had fully recovered from NB based on the train-of-four ratio caused dose-dependent decreases in genioglossus electromyogram (to 70.3 ± 7.6, 49.2 ± 3.2, and 39.7 ± 2.3% of control, respectively), decreases in diaphragm electromyogram (to 103.1 ± 6.5, 83.1 ± 4.7, and 68.7 ± 7.3% of control), and decreases in minute ventilation to a nadir value of 79.6 ± 6% of preneostigmine baseline. Genioglossus electromyogram effects were the same when neostigmine was given with no previous NB. Neostigmine caused a decrease in upper airway volume to 83 ± 3% of control, whereas end-expiratory lung volume remained constant. CONCLUSIONS: The cholinesterase inhibitor neostigmine markedly impairs upper airway dilator volume, genioglossus muscle function, diaphragmatic function, and breathing when given after recovery from vecuronium-induced neuromuscular block.

UR - http://www.scopus.com/inward/record.url?scp=34748841998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34748841998&partnerID=8YFLogxK

U2 - 10.1097/01.anes.0000281928.88997.95

DO - 10.1097/01.anes.0000281928.88997.95

M3 - Article

VL - 107

SP - 621

EP - 629

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 4

ER -