[Neostigmine and dehiscence of intestinal anastomoses (author's transl)]

In a study from 1968, anastomotic leakage was reported to be nine times as frequent if neostigmine was used for reversal of curare action than in control patients. Subsequent studies did not confirm this finding although it is not disputed that neostigmine activates bowel peristalsis. Both animal experiments and clinical observations indicate that anastomoses in undamaged bowel, if properly done, withstand all kinds of hyperperistalsis. However, it cannot entirely be excluded that coincident pathologic conditions (cachexia, damaged bowel, chronic steroid medication, anaemia etc.) may occur, in which neostigmine administration is unsafe. Appropriate anaesthesiological techniques to avoid the need for neostigmine include titration of the individual relaxant requirement by means of a peripheral nerve stimulator, preference of intermediate or short-acting nondepolarizing muscle relaxants and primary postoperative mechanical ventilation. If nevertheless reversal of residual nondepolarizing block is decided, it should be performed with deep halothane anaesthesia still maintained and by means of an anticholinesterase agent with little muscarinic side effect such as edrophonium (0.5-1.0 mg/kg).