Antimuscarinic syndrome after propofol administration in the emergency department

Antimuscarinic syndrome (AS), a rare but serious adverse event associated with propofol should be included in the differential diagnosis of patients who develop agitation after its administration. We report a case of antimuscarinic syndrome that developed in an emergency department patient immediately after receiving propofol for the reduction of an elbow dislocation. The patient had received therapeutic doses of meperidine and promethazie several hours before the administration of propofol, and had an estimated serum ethanol level of 64 mg/dL about 1 h before sedation. The patient was successfully treated with physostigmine. Administration of propofol in conjunction with other substances known to have antimuscarinic effects may increase the risk of developing AS.