Trial reportAnesthesiology2018
Neostigmine Administration after Spontaneous Recovery to a Train-of-Four Ratio of 0.9 to 1.0: A Randomized Controlled Trial of the Effect on Neuromuscular and Clinical Recovery.
Trial report in Anesthesiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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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.
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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.
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Who cites it
13 citing papers in PubMed, 40 citations in OpenAlex.
- Precision of electromyography according to the calibration approach of neuromuscular monitoring: a randomised prospective agreement study.Journal of clinical monitoring and computing · 2025Trial
- Trial
- Respiratory muscle activity after spontaneous, neostigmine- or sugammadex-enhanced recovery of neuromuscular blockade: a double blind prospective randomized controlled trial.BMC anesthesiology · 2019Trial
- Low-Dose Neostigmine at 0.7 Train-of-Four Ratio Safely Accelerates Neuromuscular Recovery: A Prospective Observational Study.Drug design, development and therapy · 2026Observational
- Risk factors for administration of additional neuromuscular block reversal in adults undergoing general anaesthesia: a single centre retrospective case-control study.BMC anesthesiology · 2025Article
- Neuromuscular block management: evidence-based principles and practice.BJA education · 2024Review
- Cautionary findings for motor evoked potential monitoring in intracranial aneurysm surgery after a single administration of rocuronium to facilitate tracheal intubation.Journal of clinical monitoring and computing · 2021Article
- Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.Anesthesiology · 2020Observational
- [Algorithm-based preventive strategies for avoidance of residual neuromuscular blocks].Der Anaesthesist · 2019Review
- Optimised reversal without train-of-four monitoring versus reversal using quantitative train-of-four monitoring: An equivalence study.Indian journal of anaesthesia · 2019Article
- Is lower-dose sugammadex a cost-saving strategy for reversal of deep neuromuscular block? Facts and fiction.BMC anesthesiology · 2018Review
- Neuromuscular Block and Blocking Agents in 2018.Turkish journal of anaesthesiology and reanimation · 2018Article
- Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade.Therapeutics and clinical risk management · 2018Review
Corrections and comments
Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhen a muscle relaxant is administered to facilitate intubation, the benefits of anticholinesterase reversal must be balanced with potential risks. The aim of this double-blinded, randomized noninferiority trial was to evaluate the effect of neostigmine administration on neuromuscular function when given to patients after spontaneous recovery to a train-of-four ratio of 0.9 or greater.
methodsA total of 120 patients presenting for surgery requiring intubation were given a small dose of rocuronium. At the conclusion of surgery, 90 patients achieving a train-of-four ratio of 0.9 or greater were randomized to receive either neostigmine 40 μg/kg or saline (control). Train-of-four ratios were measured from the time of reversal until postanesthesia care unit admission. Patients were monitored for postextubation adverse respiratory events and assessed for muscle strength.
resultsNinety patients achieved a train-of-four ratio of 0.9 or greater at the time of reversal. Mean train-of-four ratios in the control and neostigmine groups before reversal (1.02 vs. 1.03), 5 min postreversal (1.05 vs. 1.07), and at postanesthesia care unit admission (1.06 vs. 1.08) did not differ. The mean difference and corresponding 95% CI of the latter were -0.018 and -0.046 to 0.010. The incidences of postoperative hypoxemic events and episodes of airway obstruction were similar for the groups. The number of patients with postoperative signs and symptoms of muscle weakness did not differ between groups (except for double vision: 13 in the control group and 2 in the neostigmine group; P = 0.001).
conclusionsAdministration of neostigmine at neuromuscular recovery was not associated with clinical evidence of anticholinesterase-induced muscle weakness. VISUAL ABSTRACT: An online visual overview is available for this article.(Figure is included in full-text article.).
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