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Delirium treated with physostigmine: 3 case reports Three men aged 30–48 years developed delirium on emergence from anaesthesia during awake craniotomy. All three received oxybutynin 5–10mg [route, frequency, duration, indication and time to reaction onset not stated]. Remifentanil and propofol were also reported as used in one case [drug details not stated]. The men were treated with 0.5–2mg of physostigmine; two patients improved, but the agitation of the 48-year-old man did not respond. Author comment: "Physostigmine may be useful in treating agitated delirium after emergence from propofolremifentanil general anaesthesia . . . Oxybutynin may contribute to creating an anticholinergic syndrome and should be avoided in awake craniotomy." Guercio JR, et al. Physostigmine for emergence delirium during awake craniotomy: A case series. Journal of Neurosurgical Anesthesiology 23: 437 abstr. A93, No. 4, 803062539 Oct 2011. - USA

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Reactions 19 Nov 2011 No. 1378