Citation

Knuf KM, Spaulding FM, Stevens GJ. Mil. Med. 2019; ePub(ePub): ePub.

Affiliation

Department of Anesthesia, Brooke Army Medical Center, 3551 Rodger Brooke Dr, Ft Sam Houston, TX 78234.

Copyright

(Copyright © 2019, Association of Military Surgeons of the United States)

DOI

10.1093/milmed/usz086

PMID

31004425

Abstract

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.

© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en

Keywords

Central Anticholinergic Syndrome; Enhanced Recovery After Surgery; Geriatric Medicine; Perioperative Medicine