For patients with a transplanted heart, is it necessary to administer anticholinergics when antagonizing neuromuscular blockade?

For patients with a transplanted heart, is it necessary to administer anticholinergics when antagonizing neuromuscular blockade?

While bradycardia is unlikely following the administration of an acetylcholinesterase inhibitor (e.g., neostigmine) to a post-cardiac transplantation patient, the usual muscarinic blockers (e.g., glycopyrrolate) should be given concurrently to prevent noncardiac cholinergic side-effects (e.g., bron-chospasm). Another reason to provide an anticholinergic is that significantly increased levels of acetylcholine can cause coronary vasospasm in the denervated heart. While there is some evidence that neostigmine has direct effects on the myocardium, and there are a few case reports of bradycardia following neostigmine administration in this population, it should not deter one from reversing neuromuscular block-ade when appropriate because prolonged intubation may predispose to pulmonary infection.