Latasch L, Müller B, Freye E
Institut für Anästhesiologie und Schmerztherapie, Krankenhaus Nordwest, Frankfurt/Main.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2003 Aug;38(8):528-37. doi: 10.1055/s-2003-41184.
A central anticholinergic syndrome (CAS) can be related to the majority of anesthetic agents, but is often not recognized as such. Thus, most anesthesiologists seem to miss the occurrence of an anticholinergic syndrome especially when agitation and/or restlessness are the major symptoms. Therefore, the following study was undertaken to test the hypothesis that routine administration of the anticholinergic agent physostigmin is of benefit for patients in regard to vigilance, the cardiovascular system and the need of analgesics easing the time in the post anesthesia care unit (PACU).
After approval by the local ethics committee and written informed consent, 100 patients undergoing a cholecystectomy or a struma resection, were given either physostigmin (n = 51) or saline 0.9 % (n = 49) in a randomized fashion. The study was conceived to block a possible isoflurane-N2O/O2 (opioid-based plus relaxant) induced central anticholinergic syndrome and to evaluate the effects on the cardiovascular system on vigilance and on postoperative analgesic demand. Following parameters were measured: systolic and diastolic blood pressure, heart rate, respiratory rate, and arterial blood gases. In addition, vigilance was determined and typical anticholinergic symptoms (disorientation, slurred speech, agitation, nausea, emesis, cardiac arrhythmia and muscle shivering) were determined 10, 20, 40 and 60 minutes following the intravenous injection of physostigmin. Also, the need for the postoperative analgesic pethidine was evaluated among the two groups.
Except for a significant reduction in the need of analgesics, a reduced diastolic pressure and heart rate and a lower incidence of muscle shivering there was no difference among the two groups. One major side effect following the use of physostigmin was the higher incidence of nausea in the im mediate minutes following injection. This effect may be due to the rapid injection of the anticholinergic compound. Otherwise there were no detrimental effects of physostigmin in patients.
From the results it can be concluded that routine administration of an anticholinergic agent results in a short term beneficial effect in regard to vigilance, a lesser incidence of muscle shivering and a lesser demand for analgesics. However, because of the low incidence of a classical central anticholinergic syndrome, routine physostigmine is only indicated when agitation is diagnosed.
中枢抗胆碱能综合征（CAS）可能与大多数麻醉剂有关，但往往未被识别出来。因此，大多数麻醉医生似乎会忽略抗胆碱能综合征的发生，尤其是当躁动和/或不安是主要症状时。因此，开展了以下研究，以验证抗胆碱能药物毒扁豆碱的常规给药在提高警觉性、改善心血管系统以及减少镇痛需求从而缩短患者在麻醉后护理单元（PACU）停留时间方面对患者有益这一假设。
经当地伦理委员会批准并获得书面知情同意后，100例行胆囊切除术或甲状腺切除术的患者被随机给予毒扁豆碱（n = 51）或0.9%生理盐水（n = 49）。该研究旨在预防可能由异氟烷 - N₂O/O₂（基于阿片类药物加肌肉松弛剂）诱导的中枢抗胆碱能综合征，并评估其对心血管系统、警觉性和术后镇痛需求的影响。测量以下参数：收缩压和舒张压、心率、呼吸频率和动脉血气。此外，在静脉注射毒扁豆碱后的10、20、40和60分钟测定警觉性，并确定典型的抗胆碱能症状（定向障碍、言语不清、躁动、恶心、呕吐、心律失常和肌肉颤抖）。同时，评估两组患者术后对镇痛药物哌替啶的需求。
除了镇痛需求显著减少、舒张压和心率降低以及肌肉颤抖发生率较低外，两组之间没有差异。使用毒扁豆碱后的一个主要副作用是注射后即刻恶心发生率较高。这种效应可能是由于抗胆碱能化合物注射速度过快所致。除此之外，毒扁豆碱对患者没有有害影响。
从结果可以得出结论，抗胆碱能药物的常规给药在提高警觉性、降低肌肉颤抖发生率和减少镇痛需求方面产生短期有益效果。然而，由于经典中枢抗胆碱能综合征的发生率较低，仅在诊断为躁动时才建议常规使用毒扁豆碱。
