Physostigmine + Neostigmine

Hate to disagree with you, jwk, but physostigmine is, of course, a cholinesterase inhibitor, and has LONG been used as a reversal agent - don't know where you came up with idea that it has no indications as one. That being said....I certainly don't see it being used much these days at all, and have not seen any combinations as described above. Devine....sounds like an interesting mini-research project......My guess is that you will find most clinicians don't use it at all anymore. Good luck!

OK, an ACH inhibitor it is, but in 25 years, I've never seen it used for reversing NMB's. I've got a few old-fashioned tricks up my sleeve as well, but this isn't one of them.

However, I'll stand by my statement that if you have "no solid reasoning for doing so" then you shouldn't be giving any drug or treatment. If you don't have a reason for, or understand why you're doing what you're doing, then don't do it. And just doing it because someone else told you it was neat to do years ago? Not a good reason either.

Thanks for the replies! The use of physostigmine isn't my choice of routine neuromuscular blockade reversal and I've never chosen to give it over others.
The CRNA that shared this technique with me certainly has her reasoning for using it, but it is my intention to find out why it may or may not work. Obviously I don't just reach in the drug tray and give drugs without knowing all appropriate indications; but, if there are "tricks" that people have passed down over the years, I don't mind investigating one's reasoning before accepting it.

this patient population doesn't necessarily receive any anticholinergic that passes the barrier (e.g. Atropine).

Does anybody have any insight on this?
Thanks.