Background: Physostigmine is the drug of choice in the central anticholinergic syndrome, but has also been used in post-operative mental derangement secondary to sedatives and volatile anaesthetics. The aim of this double-blind, randomized, prospective study was to determine whether physostigmine alters recovery after desflurane anaesthesia. Methods: One hundred patients undergoing urologic or surgical procedures were enrolled to receive either NaCl 0.9% (n= 50) or 2 mg of physostigmine (n= 50) at the end of general anaesthesia with propofol, fentanyl, cisatracurium and desflurane. Times to extubation, stating name, birthday and place of residence, and obeying commands such as eye opening and hand squeezing were noted. Haemodynamics, Aldrete and pain scores, the analgesic requirements, and any adverse side-effects were documented until the 1st post-operative day. Results: Demographic, peri-operative data including duration of anaesthesia, surgery and postanaesthetic care unit (PACU) stay, and consumption of anaesthetics were comparable in both groups. No significant difference between the groups was found for extubation time or other emergence parameters. Patients undergoing anaesthesia >150 min showed after receiving physostigmine significantly (P < 0.05) faster spontaneous breathing (2.6 ± 3.1 vs. placebo 5.0 ± 4.2 min) and extubation time (6.2 ± 3.7 vs. placebo 8.8 ± 5.0 min). Women showed significantly shorter extubation times (5.5 ± 3.4 min) and eye opening (5.5 ± 2.6 min) with physostigmine than placebo (7.7 ± 4.5 and 7.8 ± 4.0 min). The incidence of post-operative nausea and vomiting (PONV) was significantly higher after physostigmine than placebo, whereas shivering occurred more often after placebo. Conclusion: Physostigmine does not alter desflurane-based anaesthesia compared with placebo. An option is to use physostigmine in patients with a duration of anaesthesia >150 min who profit in earlier return to spontaneous breathing and shorter extubation time.
Department of Anaesthesiology, University Hospital of Johannes Gutenberg-University Mainz, Mainz, Germany 2:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen