During reversal of competitive neuromuscular blockade with neostigmine or other anticholinesterase agents and in the management of myasthenia gravis with cholinesterase inhibitors, atropine or another mus-carinic antagonist should be given to prevent the stimulation of muscarinic receptors that accompanies excessive inhibition of AChE. However, extra care must be exercised because the prevention of muscarinic receptor stimulation eliminates an important early sign of cholinergic crisis (see Chapter 12).
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