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Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
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Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
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Neostigmine and pulmonary oedema.

Amrutha Bindu Nagella1, Mubina Begum Bijapur2, Shreyavathi Shreyavathi3

  • 1Department of Anaesthesia and Critical Care, Mahatma Gandhi Medical College & Research Institute, Pondicherry, India.

BMJ Case Reports
|September 9, 2014
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Summary

A child developed pulmonary edema after a neostigmine-glycopyrrolate mixture reversed neuromuscular blockade. Neostigmine was identified as the likely cause of this rare perioperative complication.

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Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Pharmacology

Background:

  • Neuromuscular blockade reversal is crucial in general anesthesia.
  • Neostigmine-glycopyrrolate mixtures are commonly used for reversal.
  • Pulmonary edema is a rare but serious adverse event.

Observation:

  • A 1-year-old child without prior cardiac or respiratory issues developed pulmonary edema.
  • The event occurred shortly after administration of neostigmine-glycopyrrolate.
  • Cardiac and extra-cardiac causes of pulmonary edema were excluded.

Findings:

  • Neostigmine was identified as the most probable causative agent.
  • The child experienced acute perioperative pulmonary edema.
  • Successful management of the condition was achieved.

Implications:

  • Highlights a potential adverse effect of neostigmine in pediatric anesthesia.
  • Emphasizes the need for vigilance in monitoring for pulmonary edema post-reversal.
  • Informs clinical practice regarding the safe use of neuromuscular blockade reversal agents.