Unwarranted Administration of Acetylcholinesterase Inhibitors Can Impair Genioglossus and Diaphragm Muscle Function

摘要: PARTIAL neuromuscular transmission failure (train-of-four [TOF] ratio at the adductor pollicis muscle: 0.5– 0.9) evokes dysphagia,1 aspiration,1 and a decrease in rate of maximum airflow during inspiration2,3 by partial inspiratory upper airway obstruction.4 These signs symptoms1– 4 can be difficult to detect5 because they may present even with magnitude muscle weakness insufficient evoke dyspnea or vital capacity,3–5 respiratory drive,4,6 lung volume,4 suggesting that muscles are more vulnerable NB than “pump” muscles.4 Cholinesterase inhibitors (ChEIs; e.g., neostigmine) clinically useful improve skeletal function when receptors partially blocked due lingering effects blocking agents.7,8 Therefore, it is recommended reverse agents end surgical procedure ChEI administration.7,8 This approach increases force reliably patients presenting residual blockade (NB) from short- intermediate-acting drugs.9 One possible drawback this treatment practice ChEI-based reversal agents, high doses having been applied humans some anesthesiologists,7,10 cause neuro-muscular administered who have already recovered NB.11–14 ChEIs desensitization acetylcholine receptors,13 depolarization block transmisssion,12 open channel block.15 Neuromuscular impairment could increase risk developing complications. The objective for preclinical study rats was dose–response relation on genioglossus diaphragmatic activity maintain normal dimensions.16 We hypothesized neostigmine, given after recovery (based TOF ratio), would dilatory consequently volume. further aimed explore whether giving neostigmine had as detrimental received no previous treatment.