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Central anticholinergic syndrome is due to a decrease in the inhibitory acetylcholine activity in the brain. It occurs when central cholinergic sites are occupied by specific drugs and also as a result of an insufficient release of acetylcholine.
The central anticholinergic syndrome is most commonly manifested as agitation that may progress to a hyperactive (agitated) delirium, often with pressured, incoherent speech, and visual and/or auditory hallucinations.
Central inhibition leads to an agitated (hyperactive) delirium - typically including confusion, restlessness and picking at imaginary objects - which characterises this toxidrome. Peripheral inhibition is variable - but the symptoms may include: hot, dry skin, flushed appearance, mydriasis, tachycardia, decreased bowel sounds and urinary retention.
Atropine is an antidote for cholinergic toxicity from organophosphates and nerve agents and acute treatment of bradyarrhythmias. Medications with anticholinergic properties include antidepressants, antihistamines, antiparkinson drugs, antipsychotics, antispasmodics, and mydriatics.
Central anticholinergic syndrome (CAS) is defined as an absolute or relative reduction in cholinergic activity in the central nervous system.1 In anesthesia practice, the syndrome originally was described in connection with drugs having central anticholinergic actions.
Acute anticholinergic syndrome refers to signs and symptoms caused by the inhibition of the effect of acetylcholine on muscarinic receptors. Causes: 1) Belladonna alkaloids (atropine, scopolamine, hyoscine, hyoscyamine); jimson weed (Datura stramonium), nightshade plant (Atropa belladonna), henbane (Hyoscyamus niger).
Central anticholinergic syndrome is a rare syndrome precipitated by drugs or substances that increase the release of serotonin (levodopa, and carbidopa-levodopa association, amphetamines and derivatives, cocaine), impair its reuptake (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic ...
The anticholinergic syndrome may result from oral, pulmonary (smoking), ocular, dermal, buccal, rectal, or vaginal routes of exposure to anticholinergic agents. Oral exposures are most common in reported cases and include intentional ingestion of pills, seeds, or teas.
This is not surprising considering that more than 600 drugs with significant anticholinergic properties are currently commercially available (Alpern and Marriot, 1973). This paper defines the central anticholinergic syndrome (CAS), its forms of presentation, etiology, pharmacology, and management.
In the first issue of the latest EC Pharmacology And Toxicology volume, Maggy Riad, MD, describes the incidence of anticholinergic syndrome in the perioperative and ICU settings, which often goes underdiagnosed.