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Continuing Education in Anaesthesia, Critical Care & Pain 2004 4(5):164-168; doi:10.1093/bjaceaccp/mkh045
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004 © The Board of Management and Trustees of the British Journal of Anaesthesia 2004

Anticholinesterases and anticholinergic drugs

V Priya Nair, MB BS FRCA, Honorary Lecturer
University Department of Anaesthesia, University Clinical Department, Duncan Building, Daulby Street, Liverpool, L69 3GA

Jennifer M Hunter, MB CHB PHD FRCA, Professor of Anaesthesia
University Department of Anaesthesia, University Clinical Department, Duncan Building, Daulby Street, Liverpool, L69 3GA
Tel: 01517 064008, Fax: 01517 065884, E-mail: jennie{at}liv.ac.uk (for correspondence)

Non-depolarizing neuromuscular block is monitored throughout surgery and antagonized at the end of anaesthesia to restore muscle tone rapidly and completely, so that patients can maintain a patent airway and adequate pulmonary ventilation. Rapid, reliable antagonism of competitive neuromuscular block only occurs if spontaneous recovery from block has commenced before antagonism. The agents commonly used to effect it are the anticholinesterases. By their inhibitory effect on the enzyme acetylcholinesterase, these drugs increase the amount of acetylcholine at the neuromuscular junction, thus overcoming the effects of any residual neuromuscular blocking agent.


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