Neostigmine induced coronary artery spasm: A case report and literature review

• Main Authors: Shimon Kolker, Dan Tzivoni, David Rosenmann, Shmuel Meyler, Alexander Ioscovich
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: Journal of Anaesthesiology Clinical Pharmacology
• Subjects: Anesthesia; cardiology; complication; muscle relaxants; postoperative care
• Online Access: http://www.joacp.org/article.asp?issn=0970-9185;year=2017;volume=33;issue=3;spage=402;epage=405;aulast=Kolker

Neostigmine is a cholinesterase inhibitor which does not cross the blood brain barrier and a commonly used for reversal of nondepolarizing muscle relaxants. In the following case report, we present a patient who developed coronary artery spasm, after the administration of repeated doses of neostigmine. Ours is the first case to demonstrate such a longstanding coronary artery vasospasm that lasted several hours in response to neostigmine, resulting in myocardial damage and left ventricular dysfunction. We would like to draw the attention of the anesthesiologists to this rare effect that may lead to perioperative cardiac complications.