POSTOPERATIVE OPISTHOTONUS AND TORTICOLLIS AFTER FENTANYL, ENFIURANE, AND NITROUS-OXIDE

被引:16
作者
DEHRING, DJ
GUPTA, B
PERUZZI, WT
机构
[1] OHIO STATE UNIV,COLUMBUS,OH 43210
[2] NORTHWESTERN UNIV,SCH MED,CHICAGO,IL 60611
来源
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE | 1991年 / 38卷 / 07期
关键词
ANESTHETICS; GASES; NITROUS OXIDE; INTRAVENOUS; FENTANYL; VOLATILE; ENFLURANE; ANTAGONISTS; NARCOTIC; NALOXONE; MISCELLANEOUS; PHYSOSTIGMINE; CENTRAL NERVOUS SYSTEM; EXTRAPYRAMIDAL SYSTEM SYMPTOMS AND; CENTRAL ANTICHOLINERGIC SYNDROME; SYNDROME; MUSCLE; RIGIDITY;
D O I
10.1007/BF03036975
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Most drug-induced extrapyramidal symptoms are due to blockade of dopaminergic receptors and are treated with anticholinergic drugs. We report a patient with severe postoperative extrapyramidal symptoms which responded to physostigmine and indicated a different aetiology. A young, healthy female outpatient developed severe extrapyramidal symptoms after an uneventful 50 min anaesthetic with thiopentone, fentanyl (100-mu-g), enflurane, and nitrous oxide. Although the trachea was not extubated until she obeyed commands, the patient developed opisthotonus, which resolved initially after treatment with thiopentone (40 mg), diazepam (5 mg), and diphenhydramine (50 mg). The opisthotonus recurred approximately 25 min later, in association with torticollis, obtundation, and periodic apnoea. A tentative diagnosis of central anticholinergic syndrome was proposed, and fentanyl was considered to have been responsible. Naloxone (0.4 mg) induced no improvement, but physostigmine (2 mg) reversed the dystonic symptoms and periodic apnoea and improved her mental status. The response to physostigmine may have been due specifically to increased levels of acetylcholine at the cholinergic receptors, or to a nonspecific analeptic effect.
引用
收藏
页码:919 / 925
页数:7
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