[Central anticholinergic syndrome after propofol anesthesia]

Area of Science:

• Anesthesiology
• Neuroscience
• Pharmacology

Background:

• Vertebral disc prolapse surgery necessitates anesthesia.
• Anesthesia management involves careful drug selection and monitoring.
• Central anticholinergic syndrome is a rare but serious complication.

Observation:

• A 37-year-old patient underwent two anesthesia procedures within four weeks for vertebral disc prolapse.
• The first anesthesia used volatile agents without issue.
• The second anesthesia involved total intravenous anesthesia with propofol and alfentanil.

Findings:

• Following the second anesthesia, the patient exhibited the excitatory form of central anticholinergic syndrome.
• Intravenous administration of physostigmine led to immediate and complete resolution of the syndrome's symptoms.

Implications:

• This case underscores the potential for propofol and alfentanil to induce central anticholinergic syndrome.
• Physostigmine is an effective antidote for reversing anticholinergic toxicity in the context of anesthesia.
• Clinicians should maintain awareness of this syndrome and its treatment in patients receiving these anesthetic agents.