ArticleAnesthesiology2007
Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function.
Article in Anesthesiology, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 31 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Electromyographic Activity of the Diaphragm and of the Rectus Abdominis and Intercostal Muscles During Neostigmine, Sugammadex, or Neostigmine-sugammadex Enhanced Recovery After Neuromuscular Blockade With Rocuronium. A Randomised Controlled Study in Healthy Volunteers
Effect of the Use of Atracurium With or Without Reversal Agent on Haemodynamic Parameters During Extubation: a Randomized Controlled Trial
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 105 citations in OpenAlex.
- Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review.BMC anesthesiology · 2018Pooled it
- The effect of neostigmine on postoperative delirium after colon carcinoma surgery: a randomized, double-blind, controlled trial.BMC anesthesiology · 2022Trial
- Half dose sugammadex combined with neostigmine is non-inferior to full dose sugammadex for reversal of rocuronium-induced deep neuromuscular blockade: a cost-saving strategy.BMC anesthesiology · 2017Trial
- Trial
- Current recommendations for preventing residual neuromuscular blockade.Anesthesia and pain medicine · 2026Review
- Noncardiogenic Pulmonary Edema After Neostigmine Administration During Emergence From General Anesthesia: A Case Report.Case reports in anesthesiology · 2026Article
- The association between neostigmine and postoperative atelectasis in elderly patients undergoing laparoscopic pancreaticoduodenectomy: a retrospective single-center propensity score matched study.BMC anesthesiology · 2025Article
- Comparison effects of two muscle relaxant strategies on postoperative pulmonary complications in transapical transcatheter aortic valve implantation: a propensity score-matched analysis.Journal of cardiothoracic surgery · 2023Observational
- Optimizing Reversal of Neuromuscular Block in Older Adults: Sugammadex or Neostigmine.Drugs & aging · 2022Article
- Article
- Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms.Anesthesiology · 2022Review
- Neostigmine versus sugammadex on post-operative recovery following bariatric surgery.Northern clinics of Istanbul · 2022Article
- ROUTINE USE OF SUGAMMADEX DOES NOT SHORTEN PACU LENGTH OF STAY: A PROSPECTIVE DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL.Perioperative care and operating room management · 2021Article
- Neuromuscular Block and Blocking Agents in 2018.Turkish journal of anaesthesiology and reanimation · 2018Article
- Reversal agents: do we need to administer with neuromuscular monitoring - an observational study.Indian journal of anaesthesia · 2018Article
- Article
- Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade.Therapeutics and clinical risk management · 2018Review
- Sugammadex: Appropriate Use in the Context of Budgetary Constraints.Current anesthesiology reports · 2018Review
- Observational
- Physostigmine and Methylphenidate Induce Distinct Arousal States During Isoflurane General Anesthesia in Rats.Anesthesia and analgesia · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundIt is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present. The authors hypothesized that cholinesterase inhibition when given the in absence of neuromuscular blockade (NB) would decrease upper airway dilatory muscle activity and consequently upper airway volume.
methodsThe authors measured genioglossus and diaphragm electromyograms during spontaneous ventilation in anesthetized, tracheostomized rats before and after administration of neostigmine (0.03, 0.06, or 0.12 mg/kg), after recovery of the train-of-four ratio (quadriceps femoris muscle) to unity after NB (n = 18). For comparison, the authors made the same measurements in rats that had no previous NB (n = 27). In intact anesthetized rats, the authors measured upper airway volume and end-expiratory lung volume by magnetic resonance imaging before and after 0.12 mg/kg neostigmine (n = 9).
resultsNeostigmine treatment in rats that had fully recovered from NB based on the train-of-four ratio caused dose-dependent decreases in genioglossus electromyogram (to 70.3 +/- 7.6, 49.2 +/- 3.2, and 39.7 +/- 2.3% of control, respectively), decreases in diaphragm electromyogram (to 103.1 +/- 6.5, 83.1 +/- 4.7, and 68.7 +/- 7.3% of control), and decreases in minute ventilation to a nadir value of 79.6 +/- 6% of preneostigmine baseline. Genioglossus electromyogram effects were the same when neostigmine was given with no previous NB. Neostigmine caused a decrease in upper airway volume to 83 +/- 3% of control, whereas end-expiratory lung volume remained constant.
conclusionsThe cholinesterase inhibitor neostigmine markedly impairs upper airway dilator volume, genioglossus muscle function, diaphragmatic function, and breathing when given after recovery from vecuronium-induced neuromuscular block.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.