Bradycardia and asystole following atropine-neostigmine administration after caesarean section in a parturient receiving methyldopa for pregnancy-induced hypertension

The Safety of Neuromuscular Blockade Reversal in Patients With Cardiac Transplantation

“…The discrepancy in findings between our study and aforementioned reports of cardiac arrest preceded by severe bradycardia with NMB reversal could be due to reporting bias wherein neostigmine and glycopyrrolate have been known to cause bradycardia and asystolic arrest in patients with nontransplanted, structurally normal hearts because of idiosyncrasies of the timing and route of NMB reversal administration or the presence of additional medications aggravating the hemodynamic sequelae of NMB reversal. 19 Additionally, in 5 of 6 prior reported cases of cardiac arrest after NMB reversal in cardiac transplant patients, patients were noted perioperatively to have underlying cardiac complications that may have made them more susceptible to hemodynamic perturbations, such as cellular or humoral rejection in 2 cases, 3,6 sinus node dysfunction in 2 cases, 4 and coronary artery disease in 1 case. 3 Alternatively, it is possible that although attributed to NMB reversal giving timing of occurrence, that cardiac arrest in prior reported cases was only temporally related and not caused by NMB reversal.…”

Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review

“…The authors partially attributed the event to the effects of methyldopa, which was used for the management of pregnancy-induced hypertension, but they believed that NMBR agents might have contributed. (8) In 2004, Liaquat et al presented the case of successfully managed cardiac arrest induced by routine NMBR. (6) Similar events were also described in children -Tüfek A. et al published a case of cardiac arrest in a healthy18-month-old child.…”