Coronary Artery Spasm Induced by Injection of an Atropine-neostigmine Mixture. A Case Report.
We report a case of coronary artery spasm which occurred after injection of neostigmine 3.5 mg mixed with atropine 1.5 mg to antagonize residual muscle relaxation after thyroid surgery in a 40 year-old woman with no history of heart disease. We hypothesized that increased acetylcholine levels induced by neostigmine may have elicited coronary artery spasm via mechanisms of endothelial modulation of vascular tone or activation of the autonomic nervous system. This case illustrates a rare, but serious, complication of reversal of neuromuscular blockade.