Neonatal Dhatura like poisoning - A premedication error in neonatal anesthesia

Overdosing of drugs sometimes produce fatal consequences. We report such a case of premedication dosing error in neonates with Glycopyrrolate leading to central anticholinergic syndrome (CAS) as in Dhatura poisoning. Accidental overdosing with glycopyrrolate resulted in symptoms like tachycardia, tachypnea, shock, hyperpyrexia, irritability and excessive crying. These symptoms resolved with symptomatic treatment. Errors can occur at any step of the path from drug prescription to administration. Medication errors are common and it should be immediately suspected in neonates with abnormal symptoms after injecting some drug, so that early diagnosis and treatment can be started timely. Identifying such medication errors is a challenge in neonatal care and should be a priority among caregivers in order to prevent future incidents and for patients’ safety.

Central anticholinergic syndrome (CAS) in anesthesiology: a narrative review

Psychomotor excitation, delayed recovery of consciousness after general anesthesia – well-known conditions. But only in the literature of Germany, it was first isolated in a separate central anticholinergic syndrome (CAS). This article discusses the main aspects and symptoms that will help to differentiate this syndrome with other conditions, and the methods for relief of this state.

Central anticholinergic syndrome following general anaesthesia: prevention and treatment with galantamine

Prolonged emergence, excitation and shivering after general anaesthesia are well-known, though only in German-speaking countries they are considered to be forms of single central anticholinergic syndrome (CAS), while in others this term is not associated with general anaesthesia. In Russia the problem is augmented with lack of physostigmine — the first choice for CAS in Germany. We present our analysis of implementing galantamine instead of physostigmine for CAS prevention and management while administering this drug for decurarization. 130 patients undergoing general anaesthesia were divided into three groups depending on decurarization — group I (n = 54) without decurarization, in group II (n = 29) we used galantamine, in group III (n = 47) — neostigmine. In all the groups we assessed CAS incidence and its galantamine treatment effectiveness. Diagnostic criteria for CAS comatose form was unconsciousness 5 min later reaching inhalational agent zero end-expiratory concentration. Using the criteria we found CAS incidence in group I was 26,9%, in group II there were no cases of the syndrome, in group III the incidence was 14,9%. Thus, galantamine 0,3–0,4 mg · kg–1 (max 0,78 mg · kg–1) IV not only prevents CAS but is also effective in its treatment.