Summary: Although effective in reversing the action of nondepolarizing muscle relaxants, neostigmine in combination with atropine may produce detrimental side effects, including cardiac dysrhythmias, excessive secretions, and waning of effectiveness preceding the continued action of the muscle relaxant.
Some of these problems have been reported to be eliminated by substitution of a mixture of pyridostigmine and glycopyrrolate. Therefore, the opinions of several practicing anesthesiologists were solicited. Of 10 individuals contacted, 3 stated simply that the new mixture offered insufficient advantages to even consider publishing their views, and 3 failed to reply. Of the 4 who did respond, their comments were favorable.