Priming with anti-cholinesterases--the effect of different priming doses of edrophonium

The effect of different priming doses of edrophonium were studied in 77 patients divided into seven groups (n = 11 in each). Edrophonium 1.0 mg.kg-1 was administered either in a single bolus dose (Group I; controls) or in an initial dose of 0.05, 0.1, 0.15, 0.2, 0.25 or 0.3 mg.kg-1 followed one minute later by the remainder of the 1.0 mg.kg-1 dose in Groups II to VII respectively. Reversal was attempted at ten per cent spontaneous recovery of twitch height (T1) from atracurium-induced neuromuscular blockade. Increasing the size of the priming dose from 0.05 to 0.2 mg.kg-1 resulted in a stepwise increase (p less than 0.05) in recovery of T1 and train-of-four (TOF) ratio. Higher priming doses (0.25 and 0.3 mg.kg-1) were not associated with further improvement in T1 and TOF recovery. Reversal time, that is the time taken from the first injection of edrophonium until the TOF ratio value had reached 0.75 was significantly faster (p less than 0.01) following priming with edrophonium 0.2 mg.kg-1 (Group V) when compared to Groups I, II, III, IV and VI. Reversal times were also significantly faster in Groups IV and VI when compared to the control group. It is concluded that 0.2 mg.kg-1 appears to be the optimal priming dose for administration of edrophonium in divided doses.