Table 1 Eligibility criteria for participants

• Age 18–85 years

• APACHE II score < 34

• Intra-abdominal infection

 ◦ findings of diffuse peritonitis or

 ◦ a circumscribed abscess

• Perioperative sepsis and

 ◦ secure evidence of infection,

 ◦ clinically backed up or

 ◦ secured microbiologically

 ◦ ≥ 2 of the following four criteria:

  ▪ fever ≥ 38.0 °C or

  ▪ hypothermia ≤ 36.0 °C secured by rectal intravesical or intravascular measurement

  ▪ tachycardia ≥ 90/min

  ▪ tachypnea ≥ 20/min or

  ▪ hyperventilation secured by arterial blood gas analysis with PaCO₂ ≤ 4.3 kPa or 33 mmHg or

  ▪ mechanical artificial respiration

  ▪ leukocytosis ≥ 12,000/mm³ or

  ▪ leukopenia ≤ 4000/mm³ or

  ▪ ≥ 10% immature neutrophils in the differential count

• Shock (<24 h duration): necessary use of vasopressors despite adequate fluid resuscitation to keep systolic blood pressure ≥ 90 mmHg or mean blood pressure ≥ 70 mmHg

• No more than one planned and/or one emergency procedure performed since admission (no repeated revisions)

• No infaust prognosis of a primary or concomitant illness, expecting the death within the follow-up phase

• No do-not-resuscitate order

• Written informed consent of full-age patients/their legal guardian to participate (written consent, according to AMG)

• Known hypersensitivity to physostigmine salicylate, sodium metabisulfite, sodium EDTA, or any of the other ingredients of Anticholium®

• Known contraindications [7] against Anticholium®: gangrene, coronary artery disease

• Known absolute contraindications [7] against Anticholium®: myotonic dystrophy; depolarization block by depolarizing muscle relaxants; intoxication by “irreversibly acting” cholinesterase inhibitors; closed craniocerebral trauma; obstruction in the gastrointestinal tract (mechanical constipation); obstruction in the urinary tract (mechanical urinary retention)

• Known relative contraindications [7] against Anticholium®: bronchial asthma; bradycardia; AV-conduction disturbances

• Having undergone splenectomy

• Having undergone solid organ transplantation

• Positive pregnancy test, pregnancy, and lactation

• Participation in another clinical trial, according to AMG or the follow-up phase of another study, according to AMG