Reversal of atracurium with edrophonium

The antagonistic action of a bolus dose of edrophonium 0.75 mg kg-1 on the neuromuscular blockade induced by atracurium was studied in 10 patients anaesthetized with nitrous oxide and narcotic supplements. The reversal agent was administered when the twitch height had recovered spontaneously to approximately 20% of control. Twitch response was restored to 100% of control after 4.7 +/- 2.2 min. Clinically adequate reversal (train-of-four ratio of 75% or better) was achieved 6.6 +/- 1.5 min following injection of the edrophonium and there was no evidence of subsequent muscle weakness. The possible advantages of the clinical use of edrophonium in producing a rapid reversal of atracurium blockade are discussed.