Abstract
One of the clinical indications for administering cholinesterase inhibitors, or anticholinesterases, is to reverse the effect of muscle relaxation by non-depolarizing neuromuscular blocking agents at the conclusion of surgery. The purpose of administering antimuscarinic drugs concomitantly with anticholinesterases is to minimize the muscarinic side effects associated with increased acetylcholine transmission at muscarinic receptors. In this chapter, we review anticholinesterase and anticholinergic pharmacology, including mechanism of action, dosing, and adverse effects. We discuss their clinical significance in both the surgical context and their indications outside the operating room. In addition, we briefly discuss the relaxant binding agent sugammadex and its future role in anesthesia.
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Chemical Structures
Chemical Structure 13.1
Neostigmine
Chemical Structure 13.2
Physostigmine
Chemical Structure 13.3
Pyridostigmine
Chemical Structure 13.4
Acetylcholine
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Sim, A., Vick, A. (2015). Reversal Agents. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_13
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DOI: https://doi.org/10.1007/978-1-4614-8948-1_13
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