Cardiac arrest following reversal of muscle relaxation by pyridostigmine: A case report

Jo, Jun Young; Yi, Jung Min; Lee, Yoon Kyung; Ku, Seung Woo; Park, Pyung Hwan

Case Report

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. swkoo@amc.seoul.kr
²Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea.

Received: 3 February 2014 • Revised: 25 February 2014

Abstract

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