Not that anyone else likely noticed but I omitted a very important word when
I was attempting to explain the use of glycopyrrolate.  We use it to block
certain cholinergic receptors (muscarinic) when we need to give neostigmine,
which is an acetylcholinesterase INHIBITOR. 

Basically, if we give a muscle relaxant, which binds to acetylcholine
receptors on muscle fibers, we need to be able to get the patient
breathing/moving on their own at the end of the anesthetic.  In order to
"reverse" that muscle relaxation, we give neostigmine, which prevents
acetylcholinesterase from breaking down acetylcholine at the neuromuscular
junction and thus makes a flood of acetylcholine available to overcome those
blocked receptors on the muscle fibers.  However, it could be catastrophic
to have that amount of acetylcholine available at muscarinic receptors so we
give glycopyrrolate, an anti-cholinergic, to prevent that flood of
acetylcholine from acting on the autonomic nervous system.  Simple, right? :)

Though how that might affect milk production is beyond my understanding of
lactation physiology...

-Sarah Reece-Stremtan M.D.

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