Key result
Atropine and neostigmine reversal linked to central anticholinergic syndrome in a neonate.
The use of a weight-based dose of atropine (0.01-0.02 mg/kg) rather than the recommended minimum dose of 0.1 mg may prevent central anticholinergic syndrome in neonates during neuromuscular blockade reversal.
Fixed minimum atropine dosing warrants caution in neonates; this Level 5 case leaves optimal regimens open for prospective study.
Summary Central anticholinergic syndrome (CAS) is rare in neonates. We report a case in a 10‐day‐old baby weighing 2.5 kg, following reversal of neuromuscular blockade using 0.1 mg atropine and 120 μg neostigmine. The use of atropine in 0.01‐0.02 mg.kg‐1 dose rather than the recommended minimum dose of 0.1 mg may have prevented this complication.
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Selvamani et al. (2015) studied this question. Neuromuscular blockade reversal using 0.1 mg atropine and 120 μg neostigmine caused central anticholinergic syndrome in a neonate, which a 0.01-0.02 mg/kg atropine dose may have prevented.
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