Atrial fibrillation following physostigmine

The side effects of physostigmine, a tertiary amine anticholinesterase agent commonly used to treat postanaesthetic depression caused by a large number of drugs, are thought to be fairly mild. A case is reported in which atrial fibrillation followed a total dose of 2 mg of this drug to a patient who was slow in recovering from a general anaesthetic. The arrhythmia was self-limiting and required no therapy. Indications and precautions for the use of physostigmine are discussed.