Renal failure and postoperative respiratory failure: recurarization?

The occurrence of acute postoperative respiratory failure in three patients with renal failure is presented. The most likely cause was the return of muscle paralysis after the apparent antagonism of tubocurarine by neostigmine (recurarization). In addition to reducing the dose of tubocurarine, the authors recommend that pyridostigmine be used as an antagonist instead of neostigmine because the former has a longer duration of action.