Holland M S
Nurse Anesth. 1992 Sep;3(3):121-4.
A 9-year-old child was admitted to the hospital with congenital left ureteropelvic junction obstruction with massive left pyelocaliectasis and underwent dismembered pyeloplasty of the left kidney under general anesthesia without complications. Postoperatively, the child was placed on patient-controlled analgesia, with morphine as the drug of choice. The patient was discharged to the ward with adequate pain control and no complaints of nausea or vomiting. Once on the ward, a transdermal scopolamine patch was placed for nausea and vomiting. More than 24 hours after patch placement, the child experienced central anticholinergic syndrome (CAS) with hallucinations and incontinence. The scopolamine patch was promptly removed, and all symptoms of CAS rapidly ceased. A transdermal scopolamine patch should not be used in the pediatric population, and with extreme caution in the elderly. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and possible physostigmine administration.
一名9岁儿童因先天性左肾盂输尿管连接处梗阻伴左肾巨大肾盂积水入院，在全身麻醉下接受了左肾离断性肾盂成形术，术后无并发症。术后，该儿童采用患者自控镇痛，首选药物为吗啡。患者出院时疼痛得到有效控制，无恶心或呕吐主诉。回到病房后，放置了东莨菪碱透皮贴剂以预防恶心和呕吐。贴剂放置超过24小时后，该儿童出现了伴有幻觉和失禁的中枢抗胆碱能综合征（CAS）。东莨菪碱贴剂被立即移除，CAS的所有症状迅速消失。东莨菪碱透皮贴剂不应在儿科人群中使用，在老年人中使用时应极其谨慎。CAS的治疗包括立即移除贴剂、清洁贴剂部位，并可能给予毒扁豆碱。
