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Asystole after intravenous neostigmine in a heart transplant recipient

From the Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Address correspondence to: Dr. Richard J. Bjerke, Anesthesia Service, VA Pittsburgh Health Care System, University Drive C, Pittsburgh, PA 15240 USA. Phone: 412-688-6152; Fax: 412-688-6906; E-mail: bjerkerj{at}anes.upmc.edu

Purpose: 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.

Clinical features: 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.

Conclusion: When administering anticholinesterase medications to heart transplant patients, despite surgical dennervation, one must be prepared for a possible profound cardiac response.

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