ABSTRACT

Atropine reveals itself with central findings like agitation, confusion, amnesia, hallucination, delirium and coma as well as peripherial findings like dryness in mouth and skin, tachycardia, hyperthermia, visual defect and difficulty in urination as it occupies cholinergic receptors or decreases release of acetylcholine. In this case report, the review of the concepts, accompanied with literature, related with diagnosis and treatment of central anticholinergic syndrome developed with atropine during acute phase of postoperative recovery is aimed. 68 years old female case was hemodynamically stabile during total thyroidectomy operation performed under general anesthesia. Neuromusclar block was antagonized by atropine and neostigmine. Central anticholinergic syndrome associated with atropine was considered in connection with the symptoms like agitation, space/time orientation disorder, meaningless movements, respiratory distress, tachycardia, rash on face, dryness in mouth developed following extubation. Symptomatic therapy was administered to the case that was put into postoperative intensive care unit and was transferred to surgical clinic after 24 hours of observation since her general situation was positive. Central anticholinergic syndrome associated with atropine should be considered even if high doses were not administered when anticholinergic findings were observed especially in geriatric patients during early postoperative period. While physostigmine therapy is not suggested for all patients it is recommended for serious cases.