[Central anticholinergic, neuroleptic malignant and serotonin syndromes : Important differential diagnoses in postoperative impairment of consciousness]. / Zentrales anticholinerges, malignes neuroleptisches und Serotoninsyndrom : Wichtige Differenzialdiagnosen bei postoperativen Bewusstseinsstörungen.
Anaesthesiologie
; 72(3): 157-165, 2023 03.
Article
in De
| MEDLINE
| ID: mdl-36799968
ABSTRACT
Impaired consciousness is a frequent phenomenon after general anesthesia. In addition to the classical causes (e.g., overhang of sedatives), an impairment of consciousness can also be an adverse side effect of drugs. Many drugs used in anesthesia can trigger these symptoms. Alkaloids, such as atropine can trigger a central anticholinergic syndrome, opioids can promote the occurrence of serotonin syndrome and the administration of a neuroleptic can lead to neuroleptic malignant syndrome. These three syndromes are difficult to diagnose due to the individually very heterogeneous symptoms. Mutual symptoms, such as impaired consciousness, tachycardia, hypertension and fever further complicate the differentiation between the syndromes; however, more individual symptoms, such as sweating, muscle tension or bowl sounds can be helpful in distinguishing these syndromes. The time from the trigger event can also help to differentiate the syndromes. The central anticholinergic syndrome is the fastest to appear, usually taking just a few of hours from trigger to clinical signs, serotonin syndrome takes several hours up to 1 day to show and neuroleptic malignant syndrome usually takes days. The clinical symptoms can range from mild to life-threatening. Generally, mild cases are treated with discontinuation of the trigger and extended observation. More severe cases can require specific antidotes. The specific treatment recommended for central anticholinergic syndrome is physostigmine with an initial dose of 2â¯mg (0.04â¯mg/kg body weight, BW) administered over 5â¯min. For serotonin syndrome an initial dose of 12â¯mg cyproheptadine followed by 2â¯mg every 2â¯h is recommended (maximum 32â¯mg/day or 0.5â¯mg/kgBW day-1) but this medication is only available in Germany as an oral formulation. For neuroleptic malignant syndrome 25-120â¯mg dantrolene (1-2.5â¯mg/kgBW maximum 10â¯mg/kgBW day-1) is the recommended treatment.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Antipsychotic Agents
/
Serotonin Syndrome
/
Drug-Related Side Effects and Adverse Reactions
/
Anticholinergic Syndrome
/
Neuroleptic Malignant Syndrome
Type of study:
Diagnostic_studies
Limits:
Humans
Language:
De
Journal:
Anaesthesiologie
Year:
2023
Document type:
Article