Case study

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.


1) What drug might be given to restore neuromuscular function?
-tubocurarine
-mecamylamine (Inversine)
-neostigmine (Prostigmin)
-atropine
-glycopyrrolate (Robinul)

2)How does neostigmine reverse vecuronium (Norcuron) effects that the neuromuscular junction?
- increases acetylcholine release
- blocks acetylcholine reuptake into cholinergic nerve terminals
- increases junctional acetylcholine by inhibiting acetylcholinesterase
- increases norepinephrine activity and presynaptic cholinergic terminals

3)What would be expectable side effects of neostigmine (Prostigmin)?
- smooth muscle constriction
- increase secretion
- sinus bradycardia
- all the above.

4)How can be used cholinergic side effect to be avoided?
- administration of atropine (0.02 mg/kg)
- administration glycopyrrolate (Robinul) (0.01 mg/kg)
- both
- neither

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