Only administer when the clinical signs of NDMR are wearing off or at least 2 twitches occur using train-of-four on nerve stimulator.
Neostigmine has profound cholinergic effects and, to counteract resultant profound bradycardia, is administered mixed with an anticholinergic agent, atropine or glycopyrrolate.
Whilst atropine is effective and can be used for this purpose in otherwise healthy patients, the onset of neostigmine and duration of action more closely matches that of glycopyrrolate, so this is the preferred combination agent for patients who poorly tolerate tachycardia or bradycardia.
- Neostigmine, IV, 50 mcg/kg.
WITH EITHER:
- Atropine, IV, 20 mcg/kg (maximum 1.2 mg).
OR
- Glycopyrrolate, IV, 10 mcg/kg.