Neostigmine has a longer duration of action than edrophonium and is used specifically for reversal of non-depolarising (competitive) blockade. It acts within one minute of intravenous injection and its effects last for 20 to 30 minutes; a second dose may then be necessary. Glycopyrronium given before or with neostigmine prevent bradycardia, excessive salivation and other muscarinic effects of neostigmine.
Sugammadex is a modified gamma cyclodextrin that can be used for rapid reversal of neuromuscular blockade induced by rocuronium or vecuronium. Sugammadex should only be used for rapid reversal of neuromuscular blockade in an emergency or for high risk patients.
