ABSTRACT
The central anticholinergic syndrome This is a severe confusional state that occurs within the early recovery period, and may be seen before discharge to the ward. It is rare and is caused by the action of anticholinergic drugs crossing the blood-brain barrier and affecting the central cholinergic neuronal systems of cortical arousal. The most common precipitating drugs are hyoscine (scopolamine) and atropine. Intravenous physostigmine 1-3 mg is the treatment of choice and there is rapid recovery with little likelihood of recurrence. This syndrome can occur at any age but is more common in the elderly patient. Anticholinergic drugs that do not cross the blood-brain barrier, such as glycopyrrolate, should be used whenever possible.
