title: Physostigmine reversal of drug-induced paradoxical excitement.
abstract: Paradoxical excitement associated with intravenous conscious-sedation in a patient undergoing dental surgery was successfully reversed with 1.0 mg physostigmine. Physostigmine is felt to have exerted this effect by 2 mechanisms: the re-establishment of homeostasis in the CNS via augmented cholinergic pathways with the net result being thalamacocortical excitation, and cholinergically-mediated increase in cerebral blood flow increasing the rate of redistribution of the intravenous sedative agents used. The most commonly encountered side-effects of physostigmine used to reverse parodoxical excitement, emergence delirium, or prolonged narcosis are bradycardia, nausea, and/or vomiting. The incidence of these side-effects is low in doses, below 2.0 mg/70 kg. body weight.
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced; D000766:Anesthesia, Dental / Q000009:adverse effects*; D003299:Cooperative Behavior; D003975:Diazepam / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008723:Methohexital / Q000009:adverse effects; D010830:Physostigmine / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000188:drug therapy
chemical_list: D008012:Lidocaine; D010830:Physostigmine; D008723:Methohexital; D003975:Diazepam; D005283:Fentanyl