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2003, Número 4

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Rev Mex Anest 2003; 26 (4)


Síndrome anticolinérgico en anestesia

Gómez PJ, Gutiérrez BMR, Santoyo PMN

Idioma: Español
Referencias bibliográficas: 115
Paginas: 209-216
Archivo PDF: 165.01 Kb.


RESUMEN

El síndrome anticolinérgico (SA) se presenta por antagonismo de la acetilcolina en los receptores muscarínicos, el cuadro clínico presenta dos componentes: central y periférico, manifestado con inquietud, confusión, delirio, irritabilidad, alucinaciones, midriasis, disartria, hiperreflexia, taquicardia, taquipnea, hipertensión, y en casos graves, colapso cardiovascular, convulsiones, coma y muerte. Los fármacos desencadenantes más frecuentes en anestesiología son: atropina, escopolamina, fentanyl, meperidina. Buprenorfina, metadona, ketamina, etomidato, propofol, droperidol, midazolam, diazepam, lorazepam, y anestésicos inhalados, entre los fármacos más frecuentes en anestesia. Su diagnóstico es clínico y presuntivo, descartando otras entidades como: hipercarbia, hipoxia, hipoglicemia, alteraciones neurológicas, hepáticas, renales, reacciones adversas farmacológicas, abstinencia a drogas o alcohol y dolor postquirúrgico. Su tratamiento es con fisostigmina a 0.04 mg (no disponible en nuestro país). Se recomiendan diazepam o propofol para disminuir la excitación cortical.


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