A comparison of edrophonium and neostigmine for the reversal of mivacurium-induced neuromuscular blockade in sheep

The rate of reversal of neuromuscular block was compared in 36 sheep receiving either edrophonium (500 μg kg⁻¹) and atropine (80 μg kg⁻¹), neostigmine (50 μg kg⁻¹) and atropine (80 μg kg⁻¹) or saline (10 ml), using the train of four count (TO4C) recorded at n. facialis - m. levator nasolabialis. Neuromuscular block was produced with mivacurium (200 μg kg⁻¹) followed later by a single incremental dose of 70 μg kg⁻¹. Antagonists or saline were given when spontaneous recovery from the incremental dose (T04C = 1) = 1 begun. The T04C increased from 1 to 4 in all animals, in all treatment groups within 10 minutes of reversal. The T04C was 4 in all animals five minutes after edrophonium, and seven minutes after neostigmine; differences were not statistically significant. The T04C was significantly higher with edrophonium two and three minutes after antagonism compared with saline. The data show that spontaneous recovery from mivacurium is rapid in sheep, although reversal is accelerated by anticholinesterase drugs.     

Dosage requirement of pancuronium in halothane-anesthetized ponies: a comparison of cumulative and single-dose administration

Cumulative vs single-bolus administration of pancuronium was studied in halothane-anesthetized ponies. Dosage levels were determined by giving small increments (0.01 to 0.04 mg/kg of body weight) until the desired relaxation occurred (0.125 +/- 0.038 mg/kg for 90% to 99% reduction of prerelaxant twitch height), then an additional 0.037 +/- 0.024 mg/kg for obliteration of twitch response. The dosage level defined by cumulative administration was then administered as a single bolus 2 more times, once on each of 2 days. Dosage requirements for the 2 methods correlated well. The difference in duration of paralysis caused by doses of different magnitude was compared, 1 dose to produce discernible surgical relaxation (90% to 99% reduction of twitch height) and a larger dose that obliterated discernible twitch height. The larger dose produced a significantly (P less than 0.05) longer duration of paralysis until a 10% recovery of prerelaxant twitch height was attained. The recovery phase, defined as the duration from 10% to 75% recovery of prerelaxant twitch tension, was not significantly different in ponies given either dose. Seemingly, after relaxant recovery began, the larger dose did not slow recovery. Duration of maximum paralysis until 10% recovery took 41 +/- 16 minutes for the larger dose and 10 +/- 5 minutes for the smaller dose. The recovery phase (10% to 75%) took 12 +/- 3.2 minutes and 11 +/- 4 minutes for the large and smaller doses, respectively.     

Failure to reverse prolonged vecuronium-induced neuromuscular blockade with edrophonium in an anesthetized dog

A case of prolonged muscle relaxation after vecuronium in an anesthetized dog is presented. After using peripheral nerve stimulation to confirm partial recovery of neuromuscular transmission, administration of 0.5 mg/kg IV of intravenous edrophonium failed to complete the reversal process. Subsequent administration of neostigmine resulted in complete recovery from blockade. Without monitoring neuromuscular function with a peripheral nerve stimulator until reversal was complete, it was very likely this patient would have been extubated with incomplete neuromuscular transmission. Several factors affecting the duration of neuromuscular blockade and its reversal are addressed.     

Cardiovascular and autonomic nervous effects of edrophonium and atropine combinations during neuromuscular blockade antagonism in sheep

ObjectiveTo study heart rate (HR), arterial blood pressure (BP) and autonomic nervous (AN) effects of edrophonium–atropine combinations during neuromuscular blockade (NMB) antagonism in sheep.Experimental design Randomized, prospective and experimental study.AnimalsSeventy-eight Scottish blackface ewes; mean age: 4.5 years; mean body mass: 54 kg.MethodsAfter induction with IV etomidate (0.5 mg kg⁻¹) and midazolam (0.5 mg kg⁻¹), anaesthesia was maintained with halothane and NMB produced with atracurium or mivacurium. In the first study (n = 53), the electrocardiographic (ECG), HR, BP and AN effects of low (40 μg kg⁻¹) and high (80 μg kg⁻¹) atropine doses combined with either of two edrophonium doses (0.5 or 1.0 mg kg⁻¹) were investigated. These variables were also measured in a second study when edrophonium (1.0 mg kg⁻¹) was administered 5 minutes before atropine (80 μg kg⁻¹) and vice versa. Data were analysed using one-way within-subjects and repeated measures anova.ResultsIn the first study, all combinations reversed NMB but significantly (p < 0.001) increased HR and BP within 2 minutes without arrhythmias. In the second study, edrophonium (1.0 mg kg⁻¹) significantly increased HR and BP, saliva flow (n = 1) and lung sounds (n = 3) and caused ECG changes (n = 1). Cardiovascular changes were partially reversed by atropine (80 μg kg⁻¹) administered 5 minutes later. Administered first, atropine (80 μg kg⁻¹) significantly decreased HR and BP effects which were fully (HR) and partially (BP) reversed by edrophonium (1 mg kg⁻¹) administered 5 minutes later.Conclusion and clinical relevance The cardiovascular effects of edrophonium and atropine were opposite to those reported in humans and dogs. Edrophonium (0.5 mg kg⁻¹) and atropine (80 μg kg⁻¹) caused the mildest HR changes without ECG and noncardiac AN disturbances, and is recommended for the antagonism of NMB in sheep.     

Evaluation of neostigmine antagonism at different levels of vecuronium-induced neuromuscular blockade in isoflurane anesthetized dogs

Residual neuromuscular block (NMB) during recovery from general anesthesia may be minimized by antagonizing NMB with neostigmine. We examined neostigmine for restoring neuromuscular function when administered at 2 levels of vecuronium-induced NMB in dogs. Eight healthy adult dogs received vecuronium 0.1 mg/kg body weight (BW), IV, during isoflurane anesthesia. Recovery from vecuronium occurred spontaneously (control group; C), or was enhanced with neostigmine, 0.04 mg/kg BW, IV, administered when 2 (N2) or 4 (N4) responses to train-of-four (TOF) stimulation were first observed. Duration of NMB was significantly shorter for N2 and N4 than for C. The period of complete NMB was equal for all groups; differences were observed during the recovery phase of NMB. Time of neostigmine-enhanced recovery was significantly shorter for N4 than N2, but overall duration of NMB was not reduced. Recovery from NMB was faster with neostigmine. There is no clinical advantage in delaying neostigmine administration once 2 responses to TOF are present.     

Antagonism of detomidine with tolazoline in isoflurane-anaesthetised ponies

The effects of tolazoline (4.0 mg/kg iv) antagonism of detomidine (0.02 mg/kg iv) were evaluated in isoflurane-anaesthetised, ventilated ponies. Each of 6 ponies received both tolazoline and saline treatment during separate anaesthetic episodes only (no surgery was performed). Detomidine administration produced an increase in blood pressure, decrease in heart rate and decrease in P_aO₂ Tolazoline treatment transiently increased heart rate while blood pressure returned to baseline after both treatments. Arterial oxygenation decreased further after tolazoline treatment while oxgenation recovered towards baseline with saline treatment. No other cardiopulmonary effects were detected. Recovery from anaesthesia tended to be more rapid when detomidine was antagonized. The potential benefit of antagonizing detomidine-induced bradycardia with tolazoline, during isoflurane anaesthesia should be weighed against the potential to produce a decrease in arterial oxygenation. The mechanism for this effect is not clear.     

Antagonism of xylazine-pentobarbital anesthesia by yohimbine in ponies

Effects of yohimbine on xylazine-pentobarbital anesthesia were evaluated in ponies. Five minutes after the IV injection of xylazine (1.1 mg/kg of body weight), pentobarbital sodium (12.7 mg/kg, IV) and additional xylazine (2.2 mg/kg, IM) were given and produced anesthesia in 12 ponies for 64.0 +/- 16.4 minutes (mean +/- SD) as well as immobilization for 89.8 +/- 34.2 minutes. Eleven ponies were given yohimbine (0.1 mg/kg, IV) 50 minutes after pentobarbital dosing. In these 11 ponies, durations of anesthesia and immobilization were shorter, 52.0 +/- 1.4 and 65.5 +/- 14.8 minutes, respectively. The xylazine-pentobarbital combination caused bradycardia that was reversed by yohimbine injection. Xylazine-pentobarbital produced a small, but steady, decrease of mean arterial blood pressure, which was compounded by yohimbine administration and was evident for approximately 2 minutes. Within a minute after yohimbine injection, the ponies' respiratory rate decreased and the length of inspiration and expiration and thoracic breathing increased. This lasted approximately 2 to 3 minutes and was followed by an increase in respiratory rate. The anesthesia also produced a decrease in PaO2 that gradually returned to base line in 12 control ponies, but was more pronounced in 11 ponies given yohimbine. The PaCO2, although remaining moderately high in control ponies, returned to base line after yohimbine injection. An increased pHa was seen 60 minutes after induction of anesthesia and was especially noticeable after yohimbine administration. Decreases in the number of WBC, hemoglobin content, PCV, plasma protein and serum aspartate transaminase resulting from xylazine-pentobarbital were reversed by yohimbine. Conversely, serum glucose values and creatine kinase activities were increased by xylazine-pentobarbital.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cardiopulmonary effects associated with head-down position in halothane-anesthetized ponies with or without capnoperitoneum

Objective To compare the cardiopulmonary effects of the head‐down position, with or without capnoperitoneum, in halothane‐anesthetized horses. Study design Prospective randomized study. Animals Five ponies (four mares, one stallion; bodyweight 302 ± 38.4 kg [mean ± SD]) were used. Methods The ponies were anesthetized with xylazine, guiafenesin, ketamine, and maintained with halothane/oxygen and lungs were ventilated to 40 ± 2 mm Hg (5.3 ± 0.3 kPa) end‐tidal CO₂ tension. After baseline cardiopulmonary measurements, ponies were kept in horizontal position for 30 minutes, then tilted head‐down 30° to the horizontal position for 60 minutes, and then returned to a horizontal position for final measurements. Capnoperitoneum (intra‐abdominal pressure: 12 mm Hg [1.6 kPa]) was introduced after baseline cardiopulmonary measurements, until 5 minutes before the final measurements (treatment INS). Ponies in the control treatment (CON) did not receive capnoperitoneum. Cardiopulmonary data were collected every 10 minutes following the baseline measurements until recovery. Results In the head‐down position, in both treatments, significant decreases were observed in PaO₂, and significant increases were observed in PaCO₂, right atrial blood pressure, arterial to end‐tidal CO₂ gradient, calculated V_d/V_t and ratios. During the head‐down position, in CON there was decreased cardiac index, and in INS, there were decreases in arterial plasma pH and increases in mean systemic arterial and airway pressures. Treatment INS developed ventilation–perfusion mismatch earlier in the study, and had longer recovery times compared to CON. Conclusion Cardiac index and systemic blood pressure appeared to be preserved in INS during the head‐down position, but ventilation–perfusion mismatch appeared earlier with head‐down position and capnoperitoneum. Clinical relevance Healthy ponies tolerate capnoperitoneum at 12 mm Hg (1.6 kPa) intra‐abdominal pressure when tilted head down 30° to the horizontal position.     

The effects of ephedrine on intramuscular blood flow and other cardiopulmonary parameters in halothane-anesthetized ponies

Objective To evaluate the effect of ephedrine on intramuscular blood flow and hemodynamic parameters during equine anesthesia. Study design Prospective experimental study. Animals Six healthy adult Welsh Mountain ponies (five males, one female, mean weight: 267 kg, range: 213–347 kg). Methods Halothane‐anesthetized ponies received an IV bolus of ephedrine (0.1 mg kg^?1), followed 30 minutes later by a second IV ephedrine injection (0.2 mg kg^?1). Changes in intramuscular blood flows (IMBF) in upper and lower triceps brachii were measured by laser Doppler flowmetry. Cardiopulmonary measurements were made at intervals for 30 minutes following each injection. Results were compared with values from a control group, similarly anesthetized but given saline in an earlier study. Results Ephedrine at either dose increased heart rate, arterial blood pressure (AP), cardiac index (CI) and intramuscular blood flow (IMBF), the effects on these parameters being significant and long‐lasting following the higher dose. Systemic vascular resistance remained unchanged, and was significantly lower than in the control saline group. PaO₂ decreased significantly immediately following the first injection of ephedrine, then remained unchanged for the remainder of the experiment. PaCO₂ increased slowly throughout the anesthetic period. One pony developed supraventricular premature complexes following the second injection. No other side effects were seen. Conclusion Ephedrine at dose rates of 0.2 mg kg^?1 IV consistently increased in CI, AP, and IMBF in both forelimbs. Clinical relevance Ephedrine may be of use to improve AP, CI and IMBF during halothane anesthesia, although the occurrence of an arrhythmia in one pony is of concern.     

Reversal of atracurium neuromuscular block with neostigmine in the dog

A dose response relationship and the time of onset to 50 per cent and 100 per cent peak action were investigated for neostigmine reversal of atracurium in the dog. Two levels of neuromuscular block were used, 10 per cent and 50 per cent of the first twitch of the train of four. The ED50 from the first group was 0.1 mg kg-1 and for the second group was 0.019 mg kg-1. There was little difference between the onset times at the two levels of block. It is concluded that the main factor in determining the dose of neostigmine is the depth of the initial blockade.     

Clinical use of the neuromuscular blocking agents atracurium and pancuronium for equine anesthesia

Neuromuscular blocking agents (muscle relaxants) are useful and common adjuncts to general anesthesia for human beings, but have not been used extensively during anesthesia of large animal species. Over a 3-year period, atracurium or pancuronium were used as adjuncts to general anesthesia for 89 anesthetic procedures in 88 equids (of 18 breeds and age ranging in age from 5 weeks to 25 years) at the teaching hospital. Forty-one of the anesthetic procedures were for abdominal surgery, and orthopedic (n = 19), ophthalmologic (n = 17), thoracotomy (n = 1), and soft tissue (n = 14) procedures composed the rest. Most equids were given atracurium because it was less expensive than pancuronium. Initial dosage of either relaxant ranged from 0.12 to 0.2 mg/kg of body weight IV, and repeat doses ranged from 10 to 30 mg. Relaxants were used for as long as 205 minutes. Muscles of the face or hind limb digital extensor muscles were used to monitor relaxation. Muscles of the hind limb were more sensitive to the effects of relaxants than were muscles of the face. At the end of a surgical procedure, just prior to being taken to the recovery stall, a relaxant antagonist, edrophonium (0.5 to 1 mg/kg), was administered IV to each equid. Edrophonium caused blood pressure to increase in most of the equids. Heart rate change was variable, with approximately half the equids having no change or increased heart rate and the remainder having decreased heart rate. Recovery to standing after anesthesia was rated excellent or good for 72 equids, fair for 11, and poor for 2.(ABSTRACT TRUNCATED AT 250 WORDS)     

Correction of organophosphate-induced neuromuscular blockade by diphenhydramine

Dogs exposed to topical organophosphate (fenthion) developed decreased plasma and muscle cholinesterase activities. After 2 doses were applied (1 week between doses), plasma concentrations declined 80% and muscle cholinesterase activity was reduced by 56%. Decremental responses to repetitive nerve stimulation developed after fenthion administration. Diphenhydramine, but not placebo, corrected the electrical abnormalities caused by organophosphate application, but without altering plasma or muscle cholinesterase activity. Control dogs housed in the same kennel demonstrated a slight decrease (18%) of plasma cholinesterase, which indicates that there may be potential cross contamination. Diphenydramine may be effective in treating organophosphate-induced neuromuscular weakness which is refractory to other forms of therapy.     

Effects of distention and neostigmine on jejunal vascular resistance, oxygen uptake, and intraluminal pressure changes in ponies

The influence of distention (high baseline intraluminal pressure) and neostigmine methylsulfate on intestinal vascular resistance, oxygen uptake, and intraluminal pressure changes (rhythmic contractions) was studied in terminal jejunal segments, which were perfused at a constant rate, in 16 anesthetized ponies. When baseline intraluminal pressure was increased to 10 mm of Hg, the intestinal vascular resistance and amplitude of rhythmic contractions were increased. Neostigmine induced cyclic increases in amplitude of rhythmic contractions whether intraluminal pressure was 0 or 10 mm of Hg. Neostigmine also increased intestinal oxygen uptake at intraluminal pressures of 0 mm of Hg, but not at 10 mm of Hg, and vascular resistance was not altered at either intraluminal pressure. The results indicate that intestinal hemodynamics are adversely affected by distention. Further, neostigmine did not adversely affect intestinal hemodynamics while increasing rhythmic contractions, suggesting that neostigmine may be useful in the treatment of ileus in equids.     

The effect of the organophosphate trichlorfon on the neuromuscular blocking activity of atracurium in halothane-anesthetized horses

To determine whether cholinesterase inhibition by an organophosphate would influence atracurium's neuromuscular blockade, six horses were anesthetized and paralyzed with atracurium (total of five injections per horse) on experimental Day 1, then were given trichlorfon (64 mg/kg per os) 6 days later. On Day 7, horses were anesthetized and paralyzed in the same manner as on experimental Day 1. Blood was taken to measure serum cholinesterase activity prior to anesthesia on Days 1 and 7. No significant difference was noted in atracurium's neuromuscular blocking activity between the 2 experimental days (P less than 0.05), despite Day 7 cholinesterase activity that was 16% of pre-trichlorfon values. For atracurium Injections 1 and 2-5, 85 and 43 micrograms/kg of atracurium, respectively, were required to produce a 95-99% reduction in hoof twitch. The time from injection to maximum twitch reduction was approximately 9 min after Injection 1 and 5 min after subsequent injections. Time from injection to maximum twitch reduction was significantly longer for Injection 1 than Injections 2-5 on both experimental days. The time from maximum twitch reduction until 10% recovery was approximately 8 min, with no significant difference between experimental days. The time for twitch recovery from 10 to 75% was approximately 17 min for all injections. Antagonism of atracurium with edrophonium caused the twitch height to return to pre-atracurium strength in approximately 7 min. Edrophonium caused a significant increase in arterial blood pressure. Heart rate change was variable after edrophonium.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anticholinesterase-resistant neuromuscular blockade in sheep given amino-steroid muscle relaxants

Three cases of anticholinesterase-resistant neuromuscular blockade in sheep are described. Neuromuscular blockade produced with pancuronium (n = 2) and vecuronium was only temporarily antagonised with anticholinesterases and signs of residual block-muscular weakness, recumbency, hypoventilation, dyspnoea, dysphagia, 'fade' in evoked responses to repetitive nerve stimulation and rapid exhaustion of cranial nerve reflexes - were observed. Responses to repeated edrophonium and, or neostigmine injections were incomplete and shortlived. These complications probably arose because high loading doses, incremental injections (pancuronium and vecuronium) and infusion (pancuronium) created high plasma drug concentrations at antagonism. This occurred because the facial nerve-levator nasolabialis muscle unit used to monitor drug effects proved resistant to blockade. The effects of relative overdose were probably augmented by the sensitivity of sheep to non-depolarizing neuromuscular blocking agents and the relative insensitivity of monitoring blockade using tactile and visual evaluation of evoked responses.     

Speed of reversal of vecuronium neuromuscular block with different doses of neostigmine in anesthetized dogs

Objectives

Neostigmine is routinely used to reverse non-depolarizing neuromuscular block. Given its indirect mechanism, a plateau may exist whereby increasing doses of neostigmine do not result in clinical benefit. This study was designed to measure the speed of reversal of vecuronium-induced neuromuscular block in isoflurane-anesthetized dogs after the administration of three doses of neostigmine as used in clinical practice.

The post-tetanic count during vecuronium-induced neuromuscular blockade in halothane-anaesthetized dogs

ObjectiveTo evaluate the post‐tetanic count (PTC) for predicting the return of reversible neuromuscular blockade at the n. facialis–m. nasolabialis (nF–mNL) and n. ulnaris–mm. carpi flexorii (nU–mCF) nerve‐muscle units (NMUs) during profound vecuronium neuromuscular blockade in halothane‐anaesthetized dogs.Study designRandomized, prospective, experimental study.AnimalsTwenty‐five dogs (seven male 18 female) undergoing surgery; mean age: 4.8 years; mean body weight 22 kg.MethodsThirty minutes after acepromazine (0.05 mg kg^?1) and morphine (0.5 mg kg^?1) pre‐medication, anaesthesia was induced with intravenous (IV) thiopental and maintained with halothane, N₂O and O₂. The lungs were mechanically ventilated and end‐tidal halothane concentration (Fe′_HAL) maintained at 1.04%. Neuromuscular transmission was monitored using the train‐of‐four count (TOFC) at one nF–mNL and both nU–mCF units. Vecuronium (50 µg kg^?1 IV) was injected after 15 minutes constant Fe′_HAL. When the first twitch (T1) at both nU–mCF units had disappeared (t = 0) one (randomly allocated) ulnar nerve was stimulated every 5 minutes using PTC; TOF stimulation continued at the other sites. The PTC was plotted against the interval between recording time and T1's reappearance at the other NMUs.ResultsAt t = 0, the mean PTC in the contralateral nU–mCF unit was 18 (range 0–20). Mean PTC was a minimum at t = 5, rising to the maximum (20) at 25 minutes. Six dogs were vecuronium‐resistant as monitored by PTC. Excluding data from these revealed a strong negative relationship between ulnar PTC and the time taken for T1's return at the facial (r = ?0.7018; p < 0.00001) and contralateral ulnar (r = ?0.8409; p < 0.00001) NMUs.Conclusion and clinical relevancePost‐tetanic count monitoring beginning >5 minutes after the TOFC at nU–mCF = 0 provided a reliable estimate of T1's return at ulnar and facial NMUs.     

Observations on the neuromuscular blocking action of alcuronium in the dog and its reversal by neostigmine.

The action of alcuronium chloride on neuromuscular transmission in the dogs was investigated by electrical and mechanical methods. The mean duration of action was 70 min. Reversal of its action was produced with atropine and neostigmine.     

Effects of xylazine and/or butorphanol or neostigmine on myoelectric activity of the cecum and right ventral colon in female ponies

Effects of xylazine HCl (0.5 mg/kg of body weight, IV) and/or butorphanol tartrate (0.04 mg/kg, IV) or neostigmine methylsulfate (0.022 mg/kg, IV) on myoelectric activity of the cecum and right ventral colon were studied in 4 conscious female ponies. Eight bipolar Ag/AgCl electrodes were sequentially placed on the seromuscular layer of the cecum (6 electrodes) and right ventral colon (2 electrodes). Recordings began 30 minutes before and continued for 90 minutes after drug administration. Each drug or drug combination was studied on 2 occasions in each pony. Two major patterns of coordinated spike bursts were identified. A series of coordinated spike bursts began at the cecal base and was conducted to the cecal apex (pattern I). A series of coordinated spike bursts began at the cecal apex, traversed the cecum, cecocolic orifice, and right ventral colon and was termed a progressive pattern (pattern II). Xylazine administration caused a significant decrease in patterns I and II for 20 minutes (P less than 0.05). Butorphanol tartrate administration caused a significant decrease in the progressive pattern for 10 minutes (P less than 0.05) without affecting the orally directed pattern. Administration of the combination of xylazine/butorphanol significantly decreased the frequency of pattern I for 40 minutes (P less than 0.05) and pattern II for 30 minutes (P less than 0.05). Neostigmine administration caused a significant increase in the frequency of pattern II for 30 minutes (P less than 0.05) without affecting pattern I (P greater than 0.05). Changes in conduction velocity of pattern I or II or the duration of spiking activity were not significantly different because of any treatment.     

Use of neuromuscular blockade with rocuronium bromide for intubation in cats

ObjectiveTo determine whether neuromuscular blockade with rocuronium bromide (RB) would improve endotracheal intubation (EI) conditions in comparison with topical lidocaine hydrochloride (LH).Study designRandomized prospective study.AnimalsForty seven healthy cats of unspecified breed, aged 17 ± 11 months and weighing 2.8 ± 0.8 kg, undergoing elective procedures.MethodsAnesthesia was induced with xylazine (XZ) (1.1 mg kg^?1 IM) and tiletamine‐zolazepam (XTZ) (7 mg kg^?1 IM) and EI was attempted. Cats which could not be intubated at the first attempt (n = 34), were randomly medicated with either 0.1 mL LH 10% spray on the laryngeal mucosa (n = 17) or 0.6 mg kg^?1 intravenous RB (n = 17). Sixty seconds later, a second attempt at EI was performed. The effect of both drugs was assessed using a previously published scale (Sandor Agoston). EI conditions associated with laryngoscopy, vocal cord position and movement, cough, patient movement, time and attempts needed in order to perform EI were recorded. Heart rate and end‐expired CO₂ concentration were monitored.ResultsGroups were comparable in age, weight, gender and hematological parameters. Clinically acceptable EI conditions were not significantly different between RB and LH assisted groups (p = 0.31). However, there was a significant difference in cough, vocal cord movement and position between the RB and the LH groups. The group intubated at the first attempt and receiving neither RB nor LH coughed persistently (11/13). The cats receiving RB had to be ventilated for 10–28 minutes.Conclusions and clinical relevanceThe present study shows that, when used in cats anesthetized with XTZ, RB paralyzes the internal laryngeal muscles keeping the vocal cords in an intermediate position (paramedial) 60 seconds after being administered. RB is an effective alternative to LH to overcome the airway protective reflexes when performing EI but requires ventilatory support until the paralysis wears off.