Enlon plus or Neo/Glyco

[sevoflurane]

Tell me why you choose one over the other (assuming you have both).

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[Numbex]

Neo glyco lasts longer. Hard to fault someone for using the choice that appears "safer" vs recurarization, etc, regardless of whether it's actually relevant now with NMBs that dependably go away in an hour or so. A little more hassle to draw up? Ask for pre-filled syringes. Any monkey can do that for you.

 

[Gimlet]

I've never even had edrophonium available at any of the several hospitals I rotated at during residency/fellowship, nor my current hospital and ASC.

 

[WholeLottaGame7]

Neo glyco lasts longer. Hard to fault someone for using the choice that appears "safer" vs recurarization, etc, regardless of whether it's actually relevant now with NMBs that dependably go away in an hour or so. A little more hassle to draw up? Ask for pre-filled syringes. Any monkey can do that for you.

This, plus less CNS effects with glyco vs atropine.

 

[BuzzPhreed]

The only time I used edrophonium/atropine was briefly when we couldn't get neo/glyco. No one needed to be reintubated in the PACU.

 

[deleted9493]

Higher rates of postoperative delirium with atropine use--most evident in those most susceptible (elderly and young children). Otherwise, the risk of recurarization, if reversal is given appropriately, should not be a risk even with Enlon+. The PD bit though keeps me in favor of Neo/Glyco.

 

[deleted59964]

next time i want to differentiate between a myasthenia crisis and a cholinergic crisis - I'll use edrophonium, otherwise neostigmine for me

 

[sevoflurane]

Sounds like you guys are one it. Enlon+ is nice in that it doesn't have to be mixed. Pop open and give. We wen't through a neostigmine shortage a while back and we loaded up on Enlon +. Definately noticed a difference. Not nearly as effective as neostigmine/glyco for reversal. You can reliably reverse 2/4 twitches with neo/glyco. I find that Edrophonium/atropine just isn't as robust. Despite it being a tertiatry amine, I haven't had any congnitive issues though.

Long and short is that neo/glyco is better.

 

[deleted9493]

Would anyone like to comment on reversal of a pregnant patient? Differential placental uptake of neostigmine vs. glycopyrrolate can result in fetal bradycardia, as I understand it. In these cases, I use edrophonium/atropine. Is my understanding correct re: risk of fetal bradycardia with neo/glyco?

 

[painstop]

Sounds like you guys are one it. Enlon+ is nice in that it doesn't have to be mixed. Pop open and give. We wen't through a neostigmine shortage a while back and we loaded up on Enlon +. Definately noticed a difference. Not nearly as effective as neostigmine/glyco for reversal. You can reliably reverse 2/4 twitches with neo/glyco. I find that Edrophonium/atropine just isn't as robust. Despite it being a tertiatry amine, I haven't had any congnitive issues though.

Long and short is that neo/glyco is better.

You may want to look at how much your pharmacy is charging your patients for those small 1 mL vials of glyco...it is outrageous when you multiply it by 3-5 vials. I recently told my pharmacy to switch to 5 mL vials of glyco...easier for us anesthesiologists to draw up and easier on the patient's bill (as well as probably the environment since less materials involved but that is a minor point).