Suspected Central Anticholinergic Syndrome in a 6-Week-Old Infant

Abstract

A 6-wk-old male infant became unresponsive after an uneventful general anesthetic for hernia repair. His symptoms were consistent with central anticholinergic syndrome. He appeared to awaken after treatment with IV physostigmine in a dose of 0.04 mg/kg. Because of the recurrence of sedation, a second physostigmine infusion was administered, which again led to transient arousal. Finally, the patient awoke spontaneously after 24 h and recovered uneventfully.

Central Anticholinergic Syndrome: A Case Report

“…19 The true incidence of CAS is unknown. The incidence of CAS has been reported to range from 1% to 40%.…”

Central anticholinergic syndrome vs. idiosyncratic reaction triggered by a small IV dose of atropine

“…Central anticholinergic syndrome (CAS) typically occurs in adults after large (or repeated small) doses of atropine . However, it has been suspected in a child as young as 6 weeks old . The prevalence of CAS has been previously reported to be 9.4% after general anesthesia and 3.3% after regional anesthesia with sedation .…”

“…However, in a more recent prospective study, Link et al found an incidence of only 1.9% in patients undergoing elective surgery under general anesthesia . The wide range of reported incidences may be the result of changing anesthesia practices (e.g., decrease in the use of atropine for premedication) and the challenge of diagnosing CAS …”

“…Not surprisingly, CAS occurred more frequently when the centrally active anticholinergic drugs scopolamine and atropine were routinely administered for premedication . However, more recent cases of CAS have been reported after administration of benzodiazepines, nitrous oxide, volatile anesthetics, ketamine, propofol, and etomidate .…”

Suspected Central Anticholinergic Syndrome Related to Cycloplegic Eye Drop in a Premature Baby

“…Frequencies of CAS between 1-11.2% have been reported after general anesthesia. CAS is well-defined in elderly adults but it has only been reported rarely in children (4)(5)(6)(7)(8)(9), and only a single case in infants (5).…”