A 76-year-old woman presents for urgent exploratory laparotomy. She has been receiving several medications for the management of dementia. Which of the following medications is MOST likely to interfere with neuromuscular blockade?

As the population ages, more patients are receiving drugs for the treatment of dementia. Many of these drugs have possible interactions with perioperative medications. The indication for some of the commonly used medications is based on a presumed link between loss of cholinergic input and dementia.

Anticholinesterase medications are also frequently used in the treatment of dementia (e.g., donepezil). These medications may prolong paralysis from succinylcholine and impact nondepolarizing muscle relaxants by decreasing or reversing their effects. In order to avoid this interaction, stopping these dementia medications a day before surgery has been suggested. For most medications in this category, the elimination half-life is short enough that this can be considered. Donepezil has a half-life of 70 hours...

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