Pyridostigmine과 Levosulpiride가 가토 방광의 수축에 미치는 영향

고영휘,이정구 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.2

Pyridostigmine in Pediatric Intestinal Pseudo-obstruction: Case Report of a 2-year Old Girl and Literature Review

( Giovanni Di Nardo ),( Federica Viscogliosi ),( Francesco Esposito ),( Vincenzo Stanghellini ),( Maria Pia Villa ),( Pasquale Parisi ),( Alessia Morlando ),( Girolamo Cal ),( Roberto De Giorgio ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.4

Pediatric chronic intestinal pseudo-obstruction is a rare disorder characterized by a severe impairment of gastrointestinal motility leading to intestinal obstruction symptoms in the absence of mechanical causes. The diagnosis is usually clinical and diagnostic work is usually aimed to rule out mechanical obstruction and to identify any underlying diseases. Treatment is challenging and requires a multidisciplinary effort. In this manuscript we describe the youngest child successfully treated with the orally administrable, longacting, reversible anti-cholinesterase drug, pyridostigmine. Like other drugs belonging to cholinesterase inhibitors, pyridostigmine enhances gut motility by increasing acetylcholine availability in the enteric nervous system and neuro-muscular junctions. Based on the direct evidence from the reported case, we reviewed the current literature on the use of pyridostigmine in severe pediatric dysmotility focusing on intestinal pseudo-obstruction. The overall data emerged from the few published studies suggest that pyridostigmine is an effective and usually well tolerated therapeutic options for patients with intestinal pseudo-obstruction. More specifically, the main results obtained by pyridostigmine included marked reduction of abdominal distension, reduced need of parenteral nutrition, and improvement of oral feeding. The present case and review on pyridostigmine pave the way for eagerly awaited future randomized controlled studies testing the efficacy of cholinesterase inhibitors in pediatric severe gut dysmotility. (J Neurogastroenterol Motil 2019;25:508-514)

Neuromuscular blockade reversal with sugammadex versus pyridostigmine/ glycopyrrolate in laparoscopic cholecystectomy: a randomized trial of effects on postoperative gastrointestinal motility

안지현,노희윤,김은주,이지향,우경윤,김현겸 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.2

Background: Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. Methods: We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus (‘gas-out time’) and defecation. The secondary outcome was stool types. Results: One-hundred and two patients participated (Group S [n = 49], Group P [n = 53]). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36–20.25) h in Group S and 20.85 (16.34–25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. Conclusions: Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

비탈분극성 근육이완의 길항시 Atropine, Pyridostigmine과 Glycopyrrolate, Pyridostigmine의 혼합정주가 심박수에 미치는 영향

소금영,채종한,조남수,정종달,김용일 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.1

Changes in heart rate during reversal of neuromuscular block have been a subject of clinical investigation for many years. A number of studies, have compared the effect used anticholinergics and anticholinesterase. In most studies, the drugs were administered simultaneously. Atropine and glycopyrrolate were studied in dose of 15㎕/㎏, 20㎕/㎏ and 7㎕㎕/㎏, lO㎕/㎏, given intravenously in a mixture with pyridostigmine 200㎕/㎏ at the end of operation. 15 ASA Class Ⅰ, Ⅱ patients, aged between 16 to 65, were selected in each group. Anesthesia was maintained with halothane(1.0 vol%), N20(3L/ min), O2(3L/min) and vecronium bromide 0.07㎎/㎏ was used as a muscle relaxant. The results were as follows ; 1) Atropine 15㎕/㎏, 20㎕/㎏, showed significant initial increase in pulse rate, atropine ZO㎕㎕/㎏ showed more initial increase than atropine 15㎕/㎏ Atropine 15㎕/㎏ showed more rate decrease than atropine 20㎕/㎏. 2) Gylcopyrrolate 7㎕/㎏ 10㎕/㎏ showed significant initial increase in pulse rate gylcopyrrolate 7㎕/㎏, 10㎕/㎏ showed less initial increase than atropine 15㎕/㎏, 20㎕/㎏. Atropine 20㎕/㎏ showed more late decrease than glycopyrrolate 10㎕/㎏.

중증근무력증의 증상으로 발현된 대변실금

이상수 대한신경과학회 2022 대한신경과학회지 Vol.40 No.4

I report three cases of fecal incontinence during the clinical course of myasthenia gravis. Fecal incontinence developed after withdrawal from the pyridostigmine and improved after readministration of the pyridostigmine. Myasthenia gravis could affect external anal sphincter and puborectalis function. Myasthenia gravis is presumably one of the causes of fecal incontinence. We must check for fecal incontinence in the patients with myasthenia gravis.

미용적 양악수술 시행 후 발생한 연하장애 1례

임연희,손수아,박성준,박영학 대한연하장애학회 2021 대한연하장애학회지 Vol.11 No.1

This study reports a case who presented with swallowing difficulty after orthognathic surgery. A female patient, who had undergone orthognathic surgery for esthetic purpose, presented with dysphagia. Administration of botulinum toxin injection to the cricopharyngeus muscle did not relieve or improve the severe dysphagia. The patient required nasogastric tube feeding for about three months. Swallowing ability was recovered after daily rehabilitation therapy and prescribing pyridostigmine. Injuries to the suprahyoid muscles (involved in laryngeal elevation during the pharyngeal phase of swallowing) during orthognathic surgery, and the inadvertent dissemination of inadequately injected botulinum toxin to adjacent muscles, are possible mechanisms of the severe dysphagia experienced by this patient. The authors also reviewed literature on the prevention and management of dysphagia following the orthognathic surgery.

저반응군에서의 과배란유도시 Pyridostigmine 병합요법이 혈청 및 난포액내 성장호르몬 및 인슐린유사성장인자-1 농도와 체외수정시술 결과에 미치는 영향

김정훈(JH Kim),채희동(HD Chae),강은희(EH Kang),추형식(HS Chu),강병문(BM Kang),장윤석(YS Chang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6

The Effect of Pyridostigmine Supplementation in Controlled Ovarian Hyperstimulation on Serum and Intrafollicular Levels of Growth Hormone and Insulin-like Growth Factor-1, and In Vitro Fertilization Outcome in Low Responders. Objectives: To investigate whether pyridostigmine, acetylcholinesterase inhibitor, supplementation during controlled ovarian hyperstimulation [COH] affects the serum and intrafollicular levels of growth hormone [GH] and insulin-like growth factor-1 [IGF-1] and, hence, in vitro fertilization and embryo transfer [IVF-ET] outcome in low responders. Methods: From August 1995 to May 1998, 70 infertile women with previous history of poor response to COH in IVF-ET cycles were allocated randomly to the treatment group and the control group. The COH using luteal long protocol of gonadotropin releasing hormone agonist [GnRH-a] was used in all patients. In the treatment group [n = 35], 60 mg pyridostigmine were orally administered twice daily from the first day of COH to the day of human chorionic gonadotropin [hCG] injection. The patients without pyridostigmine supplementation served as control [n = 35]. The serum concentrations of GH and IGF-1 were measured in all patients on the beginning day of COH, the 5th day of COH, and the day of hCG injection and intrafollicular concentrations of them were also measured. Results: The total number of ampules of gonadotropin required was significantly lower in the treatment group than that in the control group [p < 0.001], and the duration of gonadotropin administration was also significantly shorter in the study group [p < 0.05]. There was significantly higher concentration of serum estradiol on the day of hCG injection in the treatment group than in the control group [p < 0.05]. The mean numbers of oocytes retrieved, oocytes fertilized, and oocytes cleaved in the treatment group were also significantly higher than those in the control group [p < 0.05, p < 0.05, p < 0.05]. The mean numbers of grade I, II embryos and embryos transferred seemed to be increased in the treatment group, but the differences were not statistically significant. The clinical pregnancy rate was higher in the treatment group, but the difference did not achieve significance [25.7% vs 11.4%]. Serum GH level on the day of hCG injection was significantly higher in the treatment group than in the control group [p < 0.05]. In the treatment group, serum IGF-1 concentrations decreased to a minimal level on the day of hCG injection, after an initial rise at the midfollicular phase. Serum IGF-1 level on the 5th day of COH was significantly higher in the treatment group than in the control group [p < 0.01], but serum IGF-1 levels on the day of hCG injection were comparable between the two groups. There were significantly higher concentrations of intrafollicular GH and IGF-1 in the treatment group than in the control group [p < 0.05, p < 0.001 respectively]. Due to the use of pyridostigmine, mild transient muscle fasciculation of tongue was occurred in only 2 patients, but this side effect was subsided pontaneously. Conclusion: This study suggests that pyridostigmine supplementation during COH could affect the serum and intrafollicular GH, IGF-1 concentrations and, hence, improve the ovarian response to COH and clinical outcome in low responders undergoing IVF-ET.

The effect of pyridostigmine on bispectral index during recovery from sevoflurane anesthesia

Seol-Joo Jeong,한종인,백희정,이희승,이귀용,김종학 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.6

Background: There have been some conflicting reports showing that muscle relaxants and anticholinesterases affect the level of the bispectral index (BIS). The purpose of this study was to investigate whether pyridostigmine affects the level of the BIS during recovery from sevoflurane anesthesia. Methods: Fifty-two adult patients scheduled for laparoscopic cholecystectomy and laparoscopic appendectomy. Anesthesia was induced with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. The lung was mechanically ventilated with 1-3 vol% sevoflurane, 50% oxygen and 50% nitrous oxide. After a specimen was removed, the sevoflurane concentration was maintained at 1.5 vol%. When skin closure began, sevoflurane was stopped; however, 50% oxygen and 50% nitrous oxide were maintained. The patients then received either (1) a group that received an injection of glycopyrrolate 0.04 mg/kg and pyridostigmine 0.2 mg/kg (reverse (R) group, n = 26) or (2) a group that received normal saline (control (C) group, n = 26). Group assignment was random. Pyridostigmine, a reversible cholinesterase inhibitor, is a parasympathomimetic. End-tidal sevoflurane concentration, train of four (TOF) ratio, bispectral index (BIS), blood pressure and heart rate were measured from the end of the operation to 15 min after inject of pyridostigmine or placebo. Results: There were no significant between group differences in the time dependent decrease in end-tidal sevoflurane concentration (P = 0.0642). There were significant differences between the two groups for the time course for increases in the TOF value (P < 0.0001). There were significant differences between the two groups for the time course for increases in the BIS value (P = 0.0107). There were no significant differences in the mean BIS value up to 10 minutes after administering drug, but 15 minutes after administrating the reverse drug or the control drug, the BIS value showed significantly different BIS values: 68.2 ± 6.2 (Group R) and 63.2 ± 6.2 (Group C) (P = 0.0058). Conclusions: The finding that pyridostigmine increases TOF and BIS suggests that pyridostigmine may enhance recovery during recovery from sevoflurane anesthesia.

저반응군의 과배란유도시 Pyridostigmine 병합요법의 유용성

김정훈(JH Kim),채희동(HD Chae),강병문(BM Kang),장윤석(YS Chang),목정은(JE Mok) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

The present study was performed to investigate whether pyridostigmine, acetylcholinesterase inhibitor, co-treatment during controlled ovarian hyperstimulation (COH) would improve the clinical outcome in low responders undergoing in vitro fertilization and embryo transfer (IVF-ET). From August 1995 to October 1997, 76 infertile women with previous history of poor response to COH in IVF-ET cycles were allocated randomly to the treatment group and the control group. The COH using luteal long protocol of GnRH agonist was used in all patients. The treatment group (n=38) were administered in daily oral dosage of pyridostigmine 120 mg from the first day of COH to the day of hCG administration. The patients with no treatment served as the control. The serum concentrations of GH and IGF-I were measured in all patients on the beginning day of COH, the 5th day of COH, and the day of hCG administration, respectively. The total dose and duration of exogenous gonadotropin required in the treatment group were significantly decreased than those of the control group (36.6±11.9 vs. 49.4±12.7, 9.5±1.8 vs. 10.4±2.1, respectively), and the concentration of estradiol (E2) on the day of hCG administration in the treatment group was significantly higher than in the control group (876.1±772.9 pg/ml vs. 562.8±460.2 pg/ml). The mean numbers of oocytes retrieved, oocytes fertilized, and oocytes cleaved of the treatment group were also significantly higher than those of the control group (5.9±3.8 vs. 4.2±2.7, 4.6±2.9 vs. 3.3±1.9, 4.1±2.3 vs. 2.8±2.1, respectively). There was tendency that the mean numbers of grade I, II embryos and embryos transferred were increased in the treatment group, despite of no statistical significance. The pregnancy rate seemed to be higher in the treatment group. However, there was no significant difference between the two groups (21.1% vs. 10.5%). In addition, the concentrations of serum GH and IGF-I measured on the 5th day of COH in the treatment group were significantly higher than those of the control group. In conclusion, it was suggested that pyridostigmine co-treatment during COH could improve the ovarian response and clinical outcome in low responders undergoing IVF-ET and this study would also contribute much to effective management of infertile couples.

Effect of neuromuscular blockade reversal by pyridostigmine on spectral entropy values during recovery from desflurane anesthesia: a prospective, randomized, double-blind, controlled trial

변성혜,김유진,류재훈 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.3

Background: According to several studies investigating the relationship between muscle activity and electroencephalogram results, reversal of neuromuscular blockade (NMB) may affect depth of anesthesia indices. Therefore, we investigated the effect of pyridostigmine on these indices via spectral entropy. Methods: Fifty-six patients scheduled for thyroidectomy or parotidectomy were included in this study and randomized into two groups. At the start of skin suturing, the desflurane concentration was adjusted to 4.2 vol% in both groups. Following this, the pyridostigmine group (group P, n = 28) was administered pyridostigmine 0.2 mg/kg mixed with glycopyrrolate 0.04 mg/kg, while the control group (group C, n = 28) received normal saline. Entropy values (response entropy [RE] and state entropy [SE]), train of four (TOF) ratio, and end-tidal desflurane concentration were recorded from point of drug administration to 15 minutes post-drug administration. Results: Mean RE values at 15 minutes, when the maximum effect of pyridostigmine was anticipated, showed a statistically significant difference between groups (53.8 ± 10.5 in group P and 48.0 ± 8.8 in group C; P = 0.030). However, mean SE at 15 minutes showed no significant difference between the two groups (P = 0.066). At 15 minutes, there were significant differences in the TOF ratio between the two groups (P < 0.001). Conclusions: NMB reversal by pyridostigmine significantly increased RE values but not SE values. This finding suggests that spectral entropy may be a useful alternative tool for monitoring anesthetic depth during recovery from anesthesia in the presence of electromyogram activity.