Lastly, use of a reversal agent like neostigmine or pyridostigmine for neuromuscular blockages can also trigger a cholinergic crisis[16][17]. Neostigmine is a compound that inhibits AChE and is commonly used to reverse the effects of non-depolarizing paralytic agents like vecuronium, rocuronium, mivacurium, and pancuronium. Inhibiting AChE allows for the accumulation of ACh at the neuromuscular junction thus overcoming the competitive inhibition of non-depolarizing blocking agents. Neostigmine, like other AChE inhibitors, can stimulate the muscarinic receptors and cause the cholinergic crisis. Bronchospasm, miosis, increased peristalsis, and secretions are usually seen after administration of neostigmine.
