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To test the hypothesis that gabexate mesilate, a protease inihibitor, hastens recovery from neuromuscular blockade, we examined the effect of gabexate mesilate on the recovery of vecuronium-induced neuromuscular blockade in anaesthetized patients in a double-blind, randomized fashion.Thirty adult patients were divided into two groups of 15. In the gabexate mesilate group, immediately after administration of vecuronium 0.1 mg kg−1, a continuous infusion of gabexate mesilate was started at a speed of 1.5 mg kg−1 h−1. In the control group, normal saline was administered instead of gabexate mesilate. Times to the return of T1, T2, T3 or T4 (first, second, third and fourth response of train-of-four (TOF)), times to the recovery of T1/control to 0.25 (T25) or 0.5 (T50), recovery of T1/control or TOF ratio (T4/T1) were compared between the two groups.Times to the returns of T1, T2, T3 and T4 in the gabexate mesilate group were significantly shorter than in the control group (19.4 ± 6.8 vs. 25.7 ± 7.2 min for T1; mean ± SD, P = 0.020). Times to T25 and T50 were significantly shorter in the gabexate mesilate group than in the control group (34.0 ± 9.9 vs. 51.3 ± 10.2 min for T25, P < 0.001). T1/control and TOF ratio in the gabexate mesilate group were significantly higher than in the control group 40-80 min and 40-120 min after administration of vecuronium, respectively (P < 0.05).Gabexate mesilate hastens recovery from neuromuscular block in anaesthetized patients receiving vecuronium.