From the FDA Drug Label
The dose of neostigmine methylsulfate injection required to reverse neuromuscular blockade in children varies between 0.03 mg - 0.07 mg/kg, the same dose range shown to be effective in adults, and should be selected using the same criteria as used for adult patients. The dose of neostigmine for reversal of neuromuscular blockade in pediatric patients is 0.03 mg - 0.07 mg/kg or up to a total of 5 mg, whichever is less 1.
- The dose should be selected using the same criteria as used for adult patients.
- Infants and small children may be at greater risk of complications from incomplete reversal of neuromuscular blockade due to decreased respiratory reserve.
From the Research
The recommended dose of neostigmine for reversal of neuromuscular blockade in pediatric patients is 0.02 mg/kg administered intravenously, as guided by the most recent study 2. This dose should be given along with an anticholinergic agent, typically atropine or glycopyrrolate, to prevent the muscarinic side effects of neostigmine. Administration should be slow, over 1-2 minutes, to minimize cardiovascular effects. For optimal reversal, neostigmine should be given when there is evidence of some spontaneous recovery from neuromuscular blockade. Key points to consider when administering neostigmine for reversal of neuromuscular blockade in pediatric patients include:
- The dose of 0.02 mg/kg is based on the most recent study 2 and is recommended for pediatric patients.
- Neostigmine should be administered with an anticholinergic agent to prevent muscarinic side effects.
- Administration should be slow to minimize cardiovascular effects.
- Optimal reversal occurs when there is evidence of spontaneous recovery from neuromuscular blockade. Other studies, such as 3, 4, 5, and 6, provide additional information on the use of neostigmine and other reversal agents, but the most recent study 2 provides the most relevant guidance for pediatric patients. It is essential to consider the specific needs and circumstances of each patient when administering neostigmine for reversal of neuromuscular blockade. The use of neostigmine should be guided by the most recent and highest-quality evidence, and clinicians should be aware of the potential benefits and risks associated with its use. In pediatric patients, the dose of 0.02 mg/kg is recommended, and administration should be slow and guided by clinical judgment. Overall, the use of neostigmine for reversal of neuromuscular blockade in pediatric patients requires careful consideration of the most recent evidence and individual patient needs.