• Anteia Paraskeva, Chryssoula Staikou, Morphis Diamadis, Ioanna Siafaka, and Argyro Fassoulaki.
• Department of Anesthesiology, Aretaieion Hospital, Medical School University of Athens, 11528 Athens, Greece.
• J Clin Anesth. 2005 Dec 1;17(8):581-5.

Study ObjectiveTo evaluate the effect of physostigmine on 1.5% sevoflurane anesthesia and recovery.DesignProspective, randomized, double-blinded study.SettingOperating room of a university-affiliated, metropolitan hospital (Aretaieion Hospital and St Savas Hospital).PatientsForty female American Society of Anesthesiologists physical status I and II patients scheduled for breast biopsy.InterventionsPatients were randomly assigned in physostigmine (PHYSO) and normal-saline (NS) group. Anesthesia was induced with sevoflurane 8% using a vital capacity breath technique, and rocuronium 0.6 mg/kg was given to facilitate Laryngeal Mask Airway (LMA) No. 4 insertion. Anesthesia was maintained with end-tidal sevoflurane 1.5 minimum alveolar concentration (MAC; 3% end-tidal concentration) throughout the procedure.MeasurementsAfter skin closure and under steady-state sevoflurane anesthesia 1.5 MAC, heart rate, blood pressure, and Bispectral Index (BIS) were recorded. Immediately after, the PHYSO group received intravenous 2 mg of physostigmine, whereas the NS group received equal volume of normal saline. Bispectral Index and hemodynamic measurements were recorded 5, 8, and 10 minutes after treatment. Anesthesia was then discontinued and the LMA was removed. Zero, 15, and 30 minutes after LMA removal, patients were evaluated for orientation, sedation, sitting ability, and the "picking up matches" test, as well as for nausea and vomiting.Main ResultsNo difference was found in BIS (29 +/- 4, 32 +/- 6, 31 +/- 6, 30 +/- 7, 84 +/- 11 in the PHYSO group vs 29 +/- 6, 30 +/- 6, 30 +/- 5, 31 +/- 5, 86 +/- 7 in the NS group), hemodynamic parameters, or recovery parameters between the 2 groups at any time. No nausea or vomiting was observed in either group.ConclusionsPhysostigmine did not influence BIS values or early recovery when administered to patients anesthetized with 1.5 MAC sevoflurane anesthesia.

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