Medical Pharmacology Clinical Case: Cholinergic Drugs in Anesthesia


A 41 year-old man was admitted to the hospital with acute abdominal pain, which was diagnosed as a perforated duodenal ulcer. Laparotomy was scheduled under general anesthesia. Induction was with thiopental, and vecuronium (a neuromuscular-blocking drug) was given in a dose of 0.05 mg/kg prior to intubation. Anesthesia was maintained with nitrous oxide-isoflurane mixture, and two subsequent boluses of vecuronium 0.02 mg/kg were required to maintain 95% twitch height depression. At the close of the surgical procedure, reversal of their muscular blockade was required.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center case editor: Michael Gordon, Ph.D. Associate Professor, University of Kansas Medical Center

What drug might be given to restore neuromuscular function?
1. tubocurarine
2. mecamylamine (Inversine)
3. neostigmine (Prostigmin)
4. atropine
5. glycopyrrolate (Robinul)
How does neostigmine reverse vecuronium (Norcuron) effects that the neuromuscular junction?
1. increases acetylcholine release
2. blocks acetylcholine reuptake into cholinergic nerve terminals
3. increases junctional acetylcholine by inhibiting acetylcholinesterase
4. increases norepinephrine activity and presynaptic cholinergic terminals
What would be expectable side effects of neostigmine (Prostigmin)?
1. smooth muscle constriction
2. increase secretion
3. sinus bradycardia
4. all the above
How can be used cholinergic side effect to be avoided?
1. administration of atropine (0.02 mg/kg)
2. administration glycopyrrolate (Robinul) (0.01 mg/kg)
3. both
4. neither