Asystole after intravenous neostigmine in a heart transplant recipient.
OBJECTIVE
To describe a heart transplant recipient who developed asystole after administration of neostigmine which suggests that surgical dennervation of the heart may not permanently prevent significant responses to anticholinesterases.


METHODS
A 67-yr-old man, 11 yr post heart transplant underwent left upper lung lobectomy. He developed asystole after intravenous administration of 4 mg neostigmine with 0.8 mg glycopyrrolate for reversal of the muscle relaxant. He had no history of rate or rhythm abnormalities either prior to or subsequent to the event.


CONCLUSIONS
When administering anticholinesterase medications to heart transplant patients, despite surgical dennervation, one must be prepared for a possible profound cardiac response.
Bjerke
R J
RJ
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, PA, USA. bjerkerj@anes.upmc.edu
Mangione
M P
MP
D000368:Aged; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D003714:Denervation; D006323:Heart Arrest / Q000139:chemically induced*; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000601:surgery; D008297:Male; D009388:Neostigmine / Q000008:administration & dosage / Q000009:adverse effects*
D002800:Cholinesterase Inhibitors; D009388:Neostigmine