Death after Neostigmine Injection

The Effects of Atropine and Neostigmine on Heart Rate and Rhythm. Recommendation for Their Use to Reverse Residual Neuromuscular Block

“…The neostigmine-induced arrhythmias were attributed (Hoffman et al, 1945) to the intracardiac release of adrenaline or noradrenaline caused by the accumulated acetylcholine. In agreement with this assumption, the first three fatalities reported after the use of atropine and neostigmine for the reversal of residual neuromuscular block occurred in patients, anaesthetized with agents such as cyclopropane (Clutton-Brock, 1949;Macintosh, 1949) or ether (Hill, 1949) that sensitize the heart to adrenaline.…”

“…Soon after the introduction of neostigmineatropine combinations for the reversal of residual neuromuscular block, there appeared several reports of fatalities attributed to these agents (Hill, 1949;Clutton-Brock, 1949;Macintosh, 1949;Johnstone, 1951). At first, it was generally assumed that neostigmine was responsible for the serious arrhythmias encountered (Macintosh, 1949;Clutton-Brock, 1949;Hill, 1949;Waquet, 1951). Because of this, it has been recommended that the administration of neostigmine should be preceded by the intravenous injection of relatively large doses (1.3 mg) of atropine.…”

Edrophonium-induced asystole following neuromuscular blockade antagonism in a dog: a case report

“…Arrhythmias have not been reported in dogs during the antagonism of neuromuscular block. In contrast, neostigmine and edrophonium have caused cardiac arrest in man (Bain and Broadbent 1949;Clutton-Brock 1949;Hill 1949;MacIntosh 1949;Lawson 1956;Youngberg 1979) a n d arrhythmias a p p e a r to be relatively common. Atropine a n d neostigmine combinations have caused atrioventricular dissociation, junctional rhythm, increased P-R interval, premature atrial contractions, ectopic beats, inverted P waves, wandering pacemaker a n d premature ventricular depolarisations (Ovassapian 1969;Mirakhur, Dundee and Clarke 1977;Ostheimer 1977).…”

“…Fatal cardiac arrest is a relatively rare complication of neuromuscular blockade antagonism in man, but has been reported (Clutton-Brock 1949;Hill 1949;Bain and Broadbent 1949;MacIntosh 1949). However, heart rate changes and arrhythmias are not infrequent at this time (Atlee 1985).…”

Electrocardiographic Changes after Neostigmine-Atropine Mixture

“…Reports from as early as 1949 include deaths and cardiac events among complications after anticholinesterasics-anticholinergic use [9][10][11][12]. Adverse cardiac events were noted in conditions of cardiac disautonomy, like in heart transplanted subjects [13][14][15].…”