1Professor of Clinical Anesthesiology, Surgery and Urology, Director of Department Development, Department of Anesthesiology, University of Southern California, LA, CA, USA
2Professor Clinical Anesthesiology, UCLA Medical Center, LA, CA, USA
3Associate Professor of Clinical Anesthesiology, Department of Anesthesiology, University of Southern California, LA, CA, USA
4San Bernardine’s Medical Center, LA, CA, USA
5Associate Professor of Clinical Anesthesiology, Director of KSOM Anesthesia Medical Student Rotation, Department of Anesthesiology, University of Southern California, LA, CA, USA
6Clinical Associate Professor of Anesthesiology (Clinical Educator), Chief of Anesthesiology for Transplantation and OR Clinical Coordinator, Residency Site Director - Keck, Department of Anesthesiology, University of Southern California, LA, CA, USA
7Clinical Professor of Anesthesiology and Population and Public Health Science (Clinician Educator), Director, Employee Health, Department of Anesthesiology, University of Southern California, LA, CA, USA
8Clinical Professor of Anesthesiology, Department of Anesthesiology, University of Southern California, LA, CA, USA
Medication-induced anticholinergic syndrome may result from the concurrent administration of a single or several drugs with anticholinergic properties. It is associated with central and peripheral signs and symptoms. Central anticholinergic syndrome involves the brain structures whereas peripheral anticholinergic syndrome affects peripheral vital organ systems. Anticholinergic syndrome is commonly occurred in perioperative settings and ICU settings because there is greater need for multiple medications (polypharmacy).
Commonly used medications which have direct anticholinergic effects are atropine, scopolamine (hyoscine), and glycopyrrolate. Other medications with anticholinergic side effects are antipsychotics, antidepressants, antihistamines, anesthetic agents, sedatives, analgesics, antiemetics, anti-parkinsonian drugs, anticonvulsants, anti-dysrhythmics, medications used for urinary dysfunction, GI tract, bronchodilators, eye medications etc. The incidence in the elderly population is higher because of the decrease in cholinergic reserve and activity with the aging process. Polypharmacy incidence is highest in the ICU and post-operative settings, especially on mechanically ventilated patients. This condition is historically under-diagnosed by physicians, nurses, and other medical personnel despite the increasing use of these drugs in an aging population [1]. The incidence in the elderly population is higher because of the decrease in cholinergic reserve and decreased cholinergic receptors. Current reports indicate more than 600 medications have anti-cholinergic side effects [2].
Keywords: Anticholinergics; ICU Settings; Polypharmacy; Delirium; Anticholinergic Burden; Elderly Patients
Duraiyah Thangathurai.,et al. Anticholinergic Syndrome: An Under Diagnosed Harmful Condition in the Perioperative and ICU Settings. EC Pharmacology and Toxicology 11.1 (2023): 06-14.
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