« “Can’t ventilate/can’t intubate”, needle cricothyrotomy and jet ventilation | Main | Wrong site surgery – the five year national experience »

May 28, 2010


Rex Russell

Very nice quick reference. I would also like to include another possibility; Central anticholinergic syndrome. This etiology of delayed emergence may not be as uncommon as we thought. I believe I took care of a patient who represented an extreme case of this years ago as a new attending at Johns Hopkins. Unfortunately, I did not recognize it as such and she went to the ICU for a FULL work up(all negative) and woke up on POD 0 late in the evening with no sequelae. Had we tried a small dose of physostigmine it may have solved the mystery. I recently posted on my blog about this case.

David Smith

Thank you for your comment.
I have updated the entry
I was particularly embarrassed by the omission since one of my first published case reports as a resident was on the subject of delayed emergence after atropine (Smith DS, Gardner SM, Orkin FK: Prolonged Sedation After Intraoperative Atro¬pine in Two Elderly Patients. Anesthesiology 51:348-349, 1979).


Great idea...you have some of my favorite people contributing to your blog. I enjoy it a great deal. I'm still working out how to do links neatly but in the meantime will keep it as a post...up now.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Your comment could not be posted. Error type:
Your comment has been saved. Comments are moderated and will not appear until approved by the author. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.


Post a comment

Comments are moderated, and will not appear until the author has approved them.

Your Information

(Name and email address are required. Email address will not be displayed with the comment.)


  • Blogmaster
    This blog is organized and maintained by David S. Smith, M.D., Ph.D. Associate Professor of Anesthesiology and Critical Care, University of Pennsylvania. His subspeciality is anesthesia for patients undergoing neurosurgery. For the past 6 years he has had responsibilites for patient safety and clinical care quality improvment in a Department of over 65 faculty who provide anesthesia care for about 24,000 patients each year. Correspondance can be sent to upennanesthesiology@gmail.com
  • Mission Statement
    The purpose of this blog is primarily to provide ongoing contact with former residents and faculty of the Department of Anesthesiology and Critical Care at the University of Pennsylvania, Philadelphia, PA, U.S.A. Others may also have an interest in the topics presented. We plan to discuss a variety of issues related to the practice of anesthesiology with an emphasis on patient safety, risk management and medical legal aspects of care.
  • Disclaimer
    The content and observations on this Weblog come mostly from members of the Department of Anesthesiology and Critical Care of the University of Pennsylvania. However this material does not represent the official opinion of that Department, the University of Pennsylvania or any of its other Departments or Divisions. Medicine is a rapidly changing field. We cannot guarantee that any of the material here is correct or up to date.
Blog powered by Typepad