Management of Krait Bites

Neostigmine's Role in Anesthesia

• Neostigmine is highly effective for reversing non-depolarizing neuromuscular blocking agents used in anesthesia, by increasing acetylcholine concentration at the neuromuscular junction to overcome competitive blockade 1
• In anesthesia, neostigmine should only be administered when there are at least 4 responses to train-of-four stimulation, with continued monitoring until TOF ratio reaches ≥0.9 2, 3

Guidelines for Anesthetic Reversal

• The American Society of Anesthesiologists recommends neostigmine for reversing non-depolarizing neuromuscular blocking agents, with careful monitoring of train-of-four stimulation 2, 3