Rapid awaking after administration of neostigmine in an elderly neurosurgical patient with prolonged recovery from general anaesthesia

摘要

Editor—It is postulated that alteration of central cholinergic transmission may play an important role in the mechanism by which general anaesthetic drugs produce unconsciousness.12 It has been shown that increasing central cholinergic tone with the anticholinesterase physostigmine antagonizes the hypnotic effect of propofol or sevoflurane shown by the return of consciousness.34 In contrast, passage of neostigmine across the blood–brain barrier (BBB) is limited.5 Therefore, it is reasonable to suppose that neostigmine does not possess arousal effects like physostigmine. However, we experienced an elderly neurosurgical case in which neostigmine probably reversed prolonged recovery from general anaesthesia.