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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2014;9(3):205-208.
Published online July 31, 2014.
Cardiac arrest following reversal of muscle relaxation by pyridostigmine: A case report
Jun Young Jo, Jung Min Yi, Yoon Kyung Lee, Seung Woo Ku, Pyung Hwan Park
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea.
Received: 3 February 2014   • Revised: 25 February 2014
The anticholinesterase pyridostigmine is usually used as a reversal agent of non-depolarizing muscle relaxants in general anesthesia. Most adverse muscarinic effects of anticholinesterases are controlled by anticholinergics; however, there is still a potential for fatal cardiac complications. We report a case of cardiac arrest associated with coronary vasospasm that developed during emergence from general anesthesia in a 61-year-old male patient undergoing uvulopalatopharyngoplasty with preoperatively undiagnosed coronary vasospastic angina. Anticholinesterases should be administered with caution for neuromuscular blockade reversal, especially in patients with coronary vasospastic angina.
Key Words: Cardiac arrest, Coronary spasm, Pyridostigmine, Reversal of neuromuscular block

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