Reversal of NMB Traditionally, reversal of NMB has been accomplished with a cholinesterase inhibitor (e.g. neostigmine, pyridostigmine, edrophonium) that acts by inhibiting the breakdown of ACh in the neuromuscular junction.14 Although effective once some recovery has already taken place, cholinesterase inhibitors are associated with a number of limitations, including the induction of cholinergic adverse events (e.g. bradycardia, bronchospasm, bronchial secretions, abdominal cramping) and incomplete reversal of NMB under certain circumstances.15, 16