Salmenperä M, Nilsson E
Acta Anaesthesiol Scand. 1981 Oct;25(5):387-90. doi: 10.1111/j.1399-6576.1981.tb01671.x.
The ability of physostigmine alone and in combination with neostigmine to reverse d-tubocurarine-induced neuromuscular block was evaluated in surgical patients. The relaxation was maintained at a level of 90% twitch suppression during balanced anesthesia, and antagonism was attempted with physostigmine 1.5 mg x 3; neostigmine 0.5 mg x 3; neostigmine 1.0 mg x 3; or with a combination of physostigmine 0.75 mg and neostigmine 0.5 mg x 3. The measured parameters included the twitch force or EMG amplitude of the adductor pollicis brevis muscle after supramaximal 0.1 Hz stimulation and fading of these responses after repetitive 2 and 50 Hz stimuli. Although the restitution rate of twitch height and EMG amplitude were essentially the same with both antagonists, there was a considerable time-lag in regeneration of the fades after repetitive stimuli with physostigmine as compared with the neostigmine group. The addition of physostigmine to a subeffective dose of neostigmine resulted in antagonism comparable to that seen in other groups. The clinical antagonism was satisfactory in all patients receiving physostigmine. The divergence of relaxation-indicating parameters (twitch responses and fades) after physostigmine suggests dissimilar modes of action of two antagonists at the neuromuscular junction.
在外科手术患者中评估了毒扁豆碱单独使用及与新斯的明联合使用逆转d -筒箭毒碱诱导的神经肌肉阻滞的能力。在平衡麻醉期间，肌肉松弛维持在抑制抽搐90%的水平，并尝试用1.5 mg×3的毒扁豆碱、0.5 mg×3的新斯的明、1.0 mg×3的新斯的明，或0.75 mg毒扁豆碱与0.5 mg×3新斯的明的组合进行拮抗。测量参数包括在0.1 Hz超强刺激后拇短收肌的抽搐力或肌电图振幅，以及在2 Hz和50 Hz重复刺激后这些反应的衰减情况。尽管两种拮抗剂使抽搐高度和肌电图振幅的恢复率基本相同，但与新斯的明组相比，毒扁豆碱重复刺激后衰减恢复的时间有相当大的延迟。将毒扁豆碱添加到低于有效剂量的新斯的明中，产生的拮抗作用与其他组相当。所有接受毒扁豆碱治疗的患者临床拮抗效果均令人满意。毒扁豆碱后松弛指示参数（抽搐反应和衰减）的差异表明两种拮抗剂在神经肌肉接头处的作用方式不同。
