Effects of different doses of calcium gluconate combined with neostigmine on the recovery of neuromuscular blockade in the elderly

Background: There is high incidence of postoperative residual curarization(PORC)in elderly patients. Ionised calcium plays a significant role in the neuromuscular junction. Objective to investigate the effect of using different doses of calcium gluconate on residual neuromuscular blockade༈NMB༉after laparoscopy in elderly patients, and also to observe its clinical safety and dose-effect relationship. Methods One hundred and eighty elderly patients who underwent elective laparoscopic surgery were randomly divided into four groups, the experimental group of 5 mg/kg, 10 mg/kg, 20 mg/kg calcium gluconate injection combined with neostigmine (C 5 group, C 10 group, C 20 group) and the neostigmine group (N group), 45 cases in each group. At the end of the operation, when TOFc(train-of-four count) was ≥ 3, patients received 40 ug/kg neostigmine with 20 ug/kg atropine intravenously, while C 5 , C 10 , and C 20 group received additional calcium gluconate 5 or 10 or 20 mg/kg. The time of TOFr (T 4 /T 1 ) ≥ 0.90 and the incidence of PORC at 5, 10, 15 and 20 minutes after neostigmine administration were observed in the four groups. Results The time of TOFr ≥ 0.90 was 11.50 (9.25,14.75) min in the control group, 7.50 (6.00,9.00) min in the C 5 group, 9.50 (8.00,12.00) min in the C 10 group and 10.00 (9.00,12.00) min in the C 20 group ( P＜ 0.001). The incidence of PORC after extubation was 27 (67.5%) in N group, 21 (52.5%) in C 5 group 12 (30%) in C 10 group and 7 (17.5%) in C 20 group ( P＜ 0.001). There were no differences between the four groups with respect to the incidence of PORC at 5 and 15min after administration of neostigmine. Conclusions Calcium gluconate can be safely used for promoting early postoperative NMB recovery of cis-atracurium in elderly patients, and the recovery process was more stable in the C 20 group.