Lower Esophageal Sphincter Tone During Reversal of Neuromuscular Blockade by Atropine and Neostigmine

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Abstract
The effect on lower esophageal sphincter (LES) pressure of IV atropine and neostigmine, a drug combination routinely given to antagonize nondepolarizing neuromuscular blockade at the end of a general anesthetic, was studied in 22 patients undergoing cesarean section. Atropine 1.2 mg and neostigmine 2.5 mg IV decreased LES pressure insignificantly by a mean of 0.7 kPa (p <0.1). In contrast, atropine 1.2 mg and neostigmine 5 mg increased LES pressure by a mean of 1.4 kPa (p <0.001). The latter dosage of this drug combination, therefore, appears preferable in patients presenting for emergency surgery if the integrity of the lower esophageal sphincter is to be maintained during extubation and recovery from general anesthesia.

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