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Distinct central anticholinergic syndrome following general anaesthesia

Published online by Cambridge University Press:  16 August 2006

J. Link
Affiliation:
Freie Universität Berlin, Klinikum Benjamin Franklin, Klinik für Anaesthesiologie und Operative Intensivmedizin
G. Papadopoulos
Affiliation:
University of Joannina Medical School, GR-45110 Joannina, Germany
D. Dopjans
Affiliation:
Freie Universität Berlin, Klinikum Benjamin Franklin, Klinik für Anaesthesiologie und Operative Intensivmedizin
I. Guggenmoos-Holzmann
Affiliation:
Institut für Medizinische Statistik und Informationsverarbeitung, Hindenburgdamm 30, D-12200, Berlin
K. Eyrich
Affiliation:
Freie Universität Berlin, Klinikum Benjamin Franklin, Klinik für Anaesthesiologie und Operative Intensivmedizin
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Abstract

The purpose of this prospective study was to identify the incidence of a distinct central anticholinergic syndrome following routine anaesthesia. For 2 months, all inpatients aged more than 15 years scheduled for elective procedures and cared for in the recovery room were investigated for symptoms of the syndrome. Patients with neuropsychiatric disease or other disorders that could alter consciousness were excluded. Prolonged action of anaesthetics or relaxants, respiratory depression and metabolic disorder were ruled out before making the diagnosis. Out of 962 patients (366 men, 596 women), 18 (4 men, 14 women) developed the syndrome. The difference between men and women was not statistically significant. Six out of 60 women developed the syndrome after a hysterectomy with or without adnectomy/oophorectomy, and this high incidence was significantly different from that observed after all other procedures in women (P = 0.003) or all other gynaecological procedures (P = 0.013). The reason for this is unknown. In six of the 18 cases, untreated prolonged somnolence lasted for more than 2 h. All patients woke up after an injection of physostigmine, but six of them relapsed into somnolence and needed a second, and in one case a third, injection. The findings of the study emorders phasize that, when there is delayed recovery from anaesthesia, the diagnosis of central anticholinergic syndrome should be considered if other accessible causes for that condition have been excluded.

Type
Original Article
Copyright
1997 European Society of Anaesthesiology

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