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Objectives To describe the relationships between anticholinergic drug exposure, cholinesterase enzyme activity, inflammation, and the development of postoperative delirium in children. Design Single-center prospective cohort study. Setting Twenty-two bed PICU in a tertiary-care academic medical center in Germany. Patients A consecutive cohort of children admitted after major elective surgery. Interventions Children were screened for delirium bid over 5 consecutive postoperative days. Acetylcholinesterase and butyrylcholinesterase plasma