1.Postcardiotomy Central Anticholinergic Syndrome: Report of A Case.
Jae Won LEE ; Jeong Won KIM ; Seung Il PARK ; Meong Gun SONG ; In Cheol CHOI ; Ji Yeon SIM ; Sun Uck KWON
The Korean Journal of Thoracic and Cardiovascular Surgery 2001;34(8):634-639
Central anticholinergic syndrome is defined as an absolute or relative reduction in cholinergic activity in the central nervous system and has a wide variety of manifestations. It is associated with almost any drug given during anesthesia, except neuromuscular relaxants, and treated with the cholinesterase inhibitor physostigmine. The diagnosis of central anticholinergic syndrome is often made when symptoms resolve promptly after the administration of physostigmine. We present a case of a central anticholinergic syndrome diagnosed by treatment with physostigmine, in a patient who received closure of patent foramen ovale associated with stroke.
Anesthesia
;
Anticholinergic Syndrome*
;
Central Nervous System
;
Cholinesterases
;
Diagnosis
;
Foramen Ovale, Patent
;
Humans
;
Physostigmine
;
Stroke
2.A Suspected Case of Central Anticholinergic Syndrome after N2O-O2-Propofol Anesthesia.
Soo Jin CHUNG ; Ji Yeon SIM ; In Cheol CHOI ; Seung Il PARK
Korean Journal of Anesthesiology 2000;38(4):764-768
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.
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
3.Central Anticholinergic Syndrome Confirmed with Physostigmine after Open Heart Surgery.
Sung Keun PARK ; Seung Il HA ; Yong Bo JUNG ; Ji Yeon SIM ; Jae Won LEE ; In Cheol CHOI
Korean Journal of Anesthesiology 2001;41(5):660-664
Central anticholinergic syndrome (CAS) can be caused by many anesthetic drugs. Early diagnosis and treatment are very important because untreated CAS may result in a life-threatening condition. Physostigmine, though not available in Korea, is the only drug which can confirm and treat CAS. A forty five year old patient underwent open heart surgery due to patent foramen ovale. Anesthetic agents which were used for anesthetic induction and maintenance were midazolam, fentanyl and isoflurane. Following anesthesia, he showed irritated and excited behavior and delayed recovery from anesthesia more than 3 h after operation in the ICU, even though flumazenil and naloxone were given to rule out the residual anesthetic effect. After physostigmine 4 mg was administered intravenously, he calmed down and became more coherent. There was no evidence of neurologic deficit in the following brain MRI and neurologic examination. We report the first case of CAS confirmed with physostigmine in Korea.
Anesthesia
;
Anesthetics
;
Anticholinergic Syndrome*
;
Brain
;
Delayed Emergence from Anesthesia
;
Early Diagnosis
;
Fentanyl
;
Flumazenil
;
Foramen Ovale, Patent
;
Heart*
;
Humans
;
Isoflurane
;
Korea
;
Magnetic Resonance Imaging
;
Midazolam
;
Naloxone
;
Neurologic Examination
;
Neurologic Manifestations
;
Physostigmine*
;
Thoracic Surgery*