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PEDIATRIC ANESTHESIA

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

Peter J. Kulka, MD DEAA^*, Hakki Toker, MD, Jörg Heim, MD^*, Alexander Joist, MD, and Jens Jakschik, MD

*Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, and Department of Surgery, Prosper-Hospital, Recklinghausen, Germany; and Department of Anesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany

Address correspondence and reprint requests to P. J. Kulka, MD, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Prosper-Hospital, Mühlenstr. 27, D-45659 Recklinghausen, Germany. Address email to peter.kulka{at}prosper-hospital.de

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.

IMPLICATIONS: A 6-wk-old boy was unarousable after an uneventful general anesthetic. After eliminating other causes, a central anticholinergic syndrome seemed possible. IV physostigmine successfully reversed the comatose state and confirmed the diagnosis.