Knuf Kayla M, Spaulding Francis M, Stevens Gregory J
Department of Anesthesia, Brooke Army Medical Center, 3551 Rodger Brooke Dr, Ft Sam Houston, TX 78234.
Mil Med. 2019 Dec 1;184(11-12):937-938. doi: 10.1093/milmed/usz086.
We present a case of a 66-year-old female who was to undergo a scheduled operation and placed on our institution's ERAS (Enhanced Recovery After Surgery) protocol. The intraoperative course was unremarkable. The patient developed delayed emergence in the Post-Anesthesia Care Unit. On physical exam, the patient was noted to have a transdermal scopolamine patch adjacent to an area of skin breakdown. She also displayed signs of central anti-cholinergic toxicity including mydriasis and tachycardia. Following removal of the scopolamine patch and administration of physostigmine, her mental status returned to baseline. This interesting case highlights the importance of considering patient specific factors such as age when implementing ERAS protocols perioperatively. It also demonstrates the risks associated with scopolamine and the importance of risk/benefit analysis prior to administration.
我们报告一例66岁女性患者，她计划接受手术，并按照我们机构的加速康复外科（ERAS，即术后增强康复）方案进行处理。术中过程顺利。患者在麻醉后护理单元出现苏醒延迟。体格检查时，发现患者在皮肤破损区域附近有一片透皮东莨菪碱贴剂。她还表现出中枢抗胆碱能毒性的体征，包括瞳孔散大和心动过速。移除东莨菪碱贴剂并给予毒扁豆碱后，她的精神状态恢复至基线水平。这个有趣的病例凸显了在围手术期实施ERAS方案时考虑患者特定因素（如年龄）的重要性。它还证明了东莨菪碱相关的风险以及给药前进行风险/效益分析的重要性。
