J Korean Pain Soc.  1999 Nov;12(2):250-252.

Central Anticholinergic Syndrome by the Use of Scopolamine Patch: A case report

• Cho CD

Abstract

A 77-year-old male patient was admitted to the hospital with acute appendicitis and underwent emergency appendectomy under inhalation anesthesia without any complications. After the operation, the patient was placed on epidural analgesia with the mixture of fentanyl-bupivacaine and scopolamine patch for nausea and vomiting. The patient experienced central anticholinergic syndrome (CAS) with hallucination, confusion, somnolence, dysarthria and delirium at 20 hours after patch placement and recovered from all symptoms of CAS in 24 hours after the removal of the patch. The CAS occurs when central cholinergic sites are occupied by specific drugs and also as a result of an insufficient release of acetylcholine. The diagnosis of CAS is often determined by a process of exclusion and not actually made until a positive therapeutic response to physostigmine, a centrally active anticholiesterase agent, has taken place. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and physostigmine administration. The scopolamine patch should be used with extreme caution in elderly patient.

Keyword

Analgesia, postoperative; Complication, anticholinergic syndrome; Pharmacology, scopolamine

MeSH Terms

Acetylcholine
Aged
Analgesia, Epidural
Anesthesia, Inhalation
Anticholinergic Syndrome*
Appendectomy
Appendicitis
Delirium
Diagnosis
Dysarthria
Emergencies
Hallucinations
Humans
Male
Nausea
Physostigmine
Scopolamine Hydrobromide*
Vomiting
Acetylcholine
Physostigmine
Scopolamine Hydrobromide