Administration of depolarizing muscle relaxants after non-depolarizer reversal: when is it safe?

In the light of studies on the duration of action and pharmacokinetics of intravenous neostigmine, it is recommended that, depending upon the dosage administered, at least 1 hour should elapse before a depolarizer can safely be given after neuromuscular reversal with neostigmine, and at least 90 - 120 minutes after reversal with physostigmine. It is suggested that a diluted test dose of depolarizer be given first, and its effect monitored with a peripheral nerve stimulator because fasciculations will not occur.