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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.

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