Reversal of Neuromuscular Blockade

Anticholinesterase agents are widely used in anesthesi-ology to reverse the neuromuscular blockade caused by nondepolarizing muscle relaxants (see Chapter 28).The blockade by these drugs is competitive and can be overcome by increasing the concentration of ACh available to stimulate nicotinic cholinoreceptors at the neuro-muscular junction. Neostigmine, pyridostigmine, and edrophonium are anticholinesterase agents that are used for this purpose. Atropine or glycopyrrolate is administered in conjunction with the anticholinesterase agents to prevent the bradycardia and other side effects that result from excessive stimulation of muscarinic receptors.

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