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Neostigmine muscarinic effects — FRCA Primary MCQ

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ModeratePharmacologyNeostigmine muscarinic effectsFRCA Primary

At the end of surgery, neostigmine is given for residual non-depolarising neuromuscular blockade. The trainee co-administers glycopyrronium. What is the main reason?

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Correct answer: B — Prevention of muscarinic bradycardia

Neostigmine increases acetylcholine at nicotinic and muscarinic synapses, so an antimuscarinic reduces bradycardia, salivation and bronchial secretions. Glycopyrronium does not accelerate Hofmann elimination or encapsulate rocuronium. It has no role in malignant hyperthermia treatment or opioid rigidity. Adequate spontaneous recovery is needed before anticholinesterase reversal is effective.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care