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Related Concept Videos

Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

Indirect-Acting Cholinergic Agonists: Pharmacological Actions

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Myasthenia Gravis: Diagnostic Tests01:15

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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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Related Experiment Video

Updated: Jun 14, 2026

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation
08:24

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Low-Dose Neostigmine at 0.7 Train-of-Four Ratio Safely Accelerates Neuromuscular Recovery: A Prospective

Chang-Hoon Koo1,2, Chang Ik Choi3, Insun Park1,2

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Drug Design, Development and Therapy
|March 31, 2026
PubMed
Summary

Neostigmine administration at a train-of-four (TOF) ratio of 0.7 significantly speeds up neuromuscular recovery after anesthesia. This method is safe and effective, avoiding paradoxical muscle weakness and improving patient outcomes.

Keywords:
neostigmineneuromuscular blockadeneuromuscular recoveryparadoxical muscle weaknesstrain-of-four ratio

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuromuscular Monitoring

Background:

  • Neostigmine is used to reverse neuromuscular blockade.
  • Administering neostigmine too early can cause paradoxical muscle weakness.

Purpose of the Study:

  • To assess the efficacy and safety of neostigmine at a train-of-four (TOF) ratio of 0.7 for neuromuscular recovery.
  • To evaluate if early neostigmine administration prevents paradoxical muscle weakness.

Main Methods:

  • Prospective observational study of 54 patients undergoing thyroid surgery.
  • Neostigmine (20 mcg/kg) administered at TOF ratio of 0.7.
  • Compared recovery times and adverse events with spontaneous recovery.

Main Results:

  • Neostigmine significantly reduced recovery time (TOF 0.7 to 1.0, 0.7 to 0.9, and 0.9 to 1.0) compared to spontaneous recovery (P < 0.003).
  • No patients experienced a TOF ratio decrease or paradoxical muscle weakness post-administration.

Conclusions:

  • Administering neostigmine at a TOF ratio of 0.7 is effective and safe for neuromuscular recovery.
  • This regimen enhances surgical workflow and patient recovery times without adverse effects.