Korean J Anesthesiol.  2000 Apr;38(4):764-768. 10.4097/kjae.2000.38.4.764.

A Suspected Case of Central Anticholinergic Syndrome after N2O-O2-Propofol Anesthesia

• Chung SJ
• Sim JY
• Choi IC
• Park SI

• KMID: 2031523
• DOI: http://doi.org/10.4097/kjae.2000.38.4.764

Abstract

Central anticholinergic syndrome (CAS) is the clinical picture of the central cholinergic blockade. Many drugs used in anesthesia may cause blockade of central cholinergic neurotransmission. Early diagnosis of CAS is very important clinically, CAS's effects are broad and life-threatening. However, it is difficult to find physostigmine in Korea, which is essential to confirm a diagnosis for CAS. An 18-year-old female who was diagnosed with hyperhydrosis underwent a thoracoscopic sympathicotomy. She received N2O-O2-Propofol anesthesia. The anesthesia was unevenful, but postoperatively, she suffered from drowsiness, fever, mydriasis, stiffness of the left upper and lower extremities, and seizures. All tests to seek the cause of CAS such as blood chemistry, brain CT, brain MRI, and CSF test, were normal. She completely recovered without any sequelae after 3 days in ICU. Though it was not confirmed with physostigmine, we report the case to be suspected CAS by all other indications.

Keyword

Anesthetics: fentanyl, N2O, propofol; Complication: central anticholinergic syndrome

MeSH Terms

Adolescent
Anesthesia*
Anticholinergic Syndrome*
Brain
Brain Chemistry
Diagnosis
Early Diagnosis
Female
Fever
Humans
Korea
Lower Extremity
Magnetic Resonance Imaging
Mydriasis
Physostigmine
Seizures
Sleep Stages
Synaptic Transmission
Physostigmine