Effect of coadministration of 10 mg/kg calcium chloride and neostigmine on extubation time: A randomized controlled trial

Introduction and objectives: Some studies investigating the effect of calcium on neostigmine-induced recovery of neuromuscular blockade have shown that this combination promotes neuromuscular recovery, but does not significantly affect the incidence of postoperative residual curarization and time to extubation. This study aimed to evaluate the effects of 10 mg/kg calcium chloride co-administered with neostigmine on early recovery and time to extubation. Patients and methods: This prospective, randomized, double-blinded, placebo-controlled study included 88 ASA I-II patients aged between 18 and 65 years who were scheduled for elective surgery lasting at least 1 hour under general anaesthesia in which 10 mg/kg of calcium chloride or the same volume of normal saline was co-administered with 5 mu g/kg of neostigmine at the end of surgery. Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded. Results: Median (Q1, Q3) extubation time was significantly shorter in the calcium group vs. the placebo group (6.5 min [5.52-7.43] vs. 9.78 min [8.35-11]), P <.001. Median neuromuscular recovery time in the calcium group was 5 min vs. 7.1 min in the placebo group, P <.001. Patients in the calcium group had significantly higher TOFr and lower incidence of RNMB at 5 and 10 minutes vs. the placebo group, and no significant side effects. Conclusion: Calcium chloride at a dose of 10 mg/kg co-administered with neostigmine promotes early neuromuscular recovery and reduces time to extubation by about 32%. (c) 2024 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor.