Anticholinergic syndrome after anesthesia: a case report and review.
Anticholinergic syndrome may present with a wide variety of signs and symptoms. Central manifestations range from excitatory symptoms including delirium and agitation to central nervous system depression, stupor and coma. Anticholinergic syndrome was once a common phenomenon after general anesthesia because of the frequent administration of the anticholinergic agents atropine and scopolamine. Now that these agents are rarely administered, anesthesia-related anticholinergic syndrome is currently infrequently reported. Still, many prescription and over the counter medications as well as many anesthetic agents possess anticholinergic activity, and this diagnosis should be considered in patients with altered mental status following general anesthesia. We report a case of prolonged somnolence following general anesthesia for an MRI. A rapid improvement of mental status with physostigmine confirmed the diagnosis of anticholinergic syndrome. This case is unique in that anticholinergic syndrome-related respiratory depression was promptly reversed with physostigmine.
Brown
Douglas V
DV
Department of Anesthesiology, Rush Medical College, Rush Presbyterian St Luke's Medical Center, Chicago, Illinois 60612, USA. douglas_brown@rush.edu
Heller
Floyd
F
Barkin
Robert
R
D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000188:drug therapy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010830:Physostigmine / Q000627:therapeutic use; D015742:Propofol / Q000009:adverse effects*; D013577:Syndrome
D018686:Anesthetics, Intravenous; D002800:Cholinesterase Inhibitors; D010830:Physostigmine; D015742:Propofol