Physostigmine use in intensive care

摘要

Full recovery of patients in the intensive care (IC) unit after anaesthesia or long-term sedation is not always predictable and uneventful. Patients may fail to regain consciousness or be agitated and uncooperative. Other patients are admitted to the IC unit unconscious due to intended drug overdose, intoxication, or poisoning. Central anticholinergic syndrome (CAS), first described by Longo in 1966 [1] is an important diagnosis in these patients. Many drugs frequently used in anaesthesia and IC may induce impairment of central cholinergic transmission [2-4] and are responsible for this clinical picture, but many other clinical conditions with identical symptoms may challenge the intensivist. The differential diagnosis in IC patients is much more complicated [3, 5, 6], and includes a prolonged action of anaesthetic drugs, neurological problems like cerebral trauma, oedema, haemorrhage, ischaemia, or embolism, metabolic derangements such as hyper- or hypoglycaemia, hepatic or renal encephalopathy, acid-base disturbances, electrolyte abnormalities, endocrino-pathies like thyrotoxicosis, hypo- and hyperadrenalcorticism, body temperature dysregulation, respiratory problems causing hypo- or hypercapnia or hypoxia, and psychiatric pathology like organic psycho-syndrome or acute psychosis. Administration of physostigmine, a centrally active cholinesterase inhibitor, can be useful in those patients where central acetylcholine deficit may be a problem.