Central anticholinergic syndrome – forgotten diagnosis

Authors: J. Vagner 1;  J. Votava 1;  A. Spálený 1
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny 1. lékařská fakulta Univerzity Karlovy a Ústřední vojenská, nemocnice Praha
Published in: Anest. intenziv. Med., 32, 2021, č. 3, s. 164-167


Our article presents a case report of patient with persistent impaired consciousness on awakening from general anesthesia. A 65-year-old patient with Crohn’s disease was indicated for scheduled laparoscopic assisted ileocecal resection. The operation was performed without complications under general anesthesia. In the immediate post-anesthetic period, a quantitative disorder of consciousness of the nature of significant somnolence to sopor dominated. The state of consciousness did not improve over time and therefore naloxone and aminophyllin were administered to patients with a suspected prolonged opiate effects. However, their administration did not lead to an adjustment of the consciousness. After excluding all other causes of disturbances of consciousness, we considered central anticholinergic syndrome (CAS) and proceeded to the administration of physostigmine. Patients regained full alertness, accelerated psychomotor pace, and improved muscle strength within a minute. Further course of hospitalization without any sights.


prolonged recovery from anesthesia – physostigmine – anticholinergic syndrome


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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

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