Dear Collegue,   extrapyramidal syndrome after a procedure under councious sedation is very uncommon in my past experience as Anaesthesiologist of a great Institute (San Rafael Hospital at Milan),  despite the fact that it is often cited in the literature .

I think that the use of Scopolamine could be an aggravating circumstance of the event.

Best  Wishes,  GFV

Midazolam theoreticaly and practically should prevent the extrapyramidal syndrome occurence. Whenever an extrapyramidal syndrome occurs, immediate interruption of the suspected drug should be performed and benziodiazepines administered (diazepam, valium to maximum 0.1 - 0.3mg/kg). 

We used to experience the aforementioned syndrome following an admixture of a butirophenone (dihidrobezperidol - droperidol) and fentanyl. This is history since droperidol was banished due of its effect on the QT segment. 

All the best,

S Copotoiu

Was ondansetron another medication that was administered? It would be common to do so and then a much more likely etiology.

Ondansetron was not given as there were no nausea problems. The EPS symptoms dissapered after 6 h. teh rest of the follow up was uneventful.