Tardive syndromes are much lower in prevalence in second generation antipsychotics (SGA) than in the typical antipsychotics. Although, olanzapine, which is an SGA, has a high risk of causing weight gain, metabolic syndrome, raised blood sugar, and dyslipidemias; it is widely used as the risk of developing extrapyramidal syndromes (EPS) is low. Among the various forms of EPS, tardive syndromes are the most feared, tardive dyskinesia, tardive akathisia, and tardive dystonia are the commonest tardive syndromes, the others being less common. Tardive oculogyric crises (TOC) are a rare form of tardive dystonia. This patient had TOC with prolonged unsupervised treatment with low-dose olanzapine. Added to that, she developed weight gain that was alarmingly high and such high gain in weight with olanzapine, to our knowledge, has not been reported. She responded to a low dose of trihexiphenydyl, and on stopping olanzapine and adding aripiprazole, has started losing weight.
Introduction: Postoperative Sore Throat (POST) is a frequently encountered complication after general anaesthesia with tracheal intubation and positional changes. Magnesium Sulphate (MgSO4) is a N-Methyl D-Aspartate (NMDA) receptor antagonist and dexamethasone is a glucocorticoid, both drugs helps in reducing POST by various mechanisms. Aim: To compare the effects of preoperative dexamethasone nebulisation vs preoperative MgSO4 nebulisation on sore throat in prone position surgeries. Materials and Methods: Eighty patients undergoing lumbar spine surgeries from October 2017 to April 2019, under general anaesthesia in prone position, were randomly allocated into two groups- A and B. Thirty minutes before surgery patients in each group were nebulised with respective drugs, dexamethasone 8 mg in group A and 250 mg of MgSO4 in group B. Haemodynamic parameters during laryngoscopy were noted. A standardised protocol for providing general anaesthesia was followed for all patients. After extubation, at 0, 4, 6 and 24 hours all patients were asked to grade POST, hoarseness and cough. The severity of POST was graded with four-point scale. Continuous variables were expressed as mean±SD and analysed using student t-test. The p-value <0.05 was considered statistically significant. Results: The overall incidence of sore throat in dexamethasone group was 37.5% and 20% in MgSO4 group. The incidence (p=0.026) and severity (p=0.011) of POST was significantly decreased in MgSO4 group at 6 hours where none of the patient had sore throat compared to dexamethasone where 15 (37.5%) of them had sore throat (p=0.026). None of the patients had cough and hoarseness in both groups. Conclusion:Nebulisation with MgSO4preoperatively significantly decreases the incidence and severity of POST when compared to dexamethasone and there was no statistically significant haemodynamic variability between the two groups.
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