Hiccup: Mystery, Nature and Treatment

Abstract

Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

Postoperative Hiccup Induced by LMA—A Case Report with Literature Review

“…In the case reports on hiccups related to laryngeal mask airway insertion or removal after induction of anaesthesia with propofol, it is uncertain whether some cases of perioperative hiccups are the direct effect of surgery [17]. Injury to the delicate tissues of the upper airway during the LMA removal is a possibility in this patient that developed a postoperative hiccup.…”

“…Propofol induction during anaesthesia has been associated with perioperative hiccups [10] [12]. Overall, it is uncertain whether some cases of postoperative hiccups are the effect of direct surgery or secondary to anaesthetic agent [17]. Gataure et al [4], compared 50 patients in whom LMA were removed while they were deeply anaesthetized with 50 others in whom the LMA were removed when they were awake and observed that complications during LMA removal were significantly more in the awake group.…”

Persistant hiccups due to the use of intravenous metilprednisolone in a patient wit relapsing remitting multiple sclerosis: a case report and literature review

“…Hiccups are reflex actions due to the sudden contraction of diaphragm by the stimulation of nervus phrenicus, which is generally self-limiting, and benign 1 . The medical term for this condition is 'Singultus', which can be defined as 'to be caught in the act of sobbing' 6 .…”

“…Hiccups can be defined as the sudden, uncontrolled contractions of the diaphragm, followed by immediate inspiration and closure of the glottis over the trachea 1 . It is a common problem in general population, and may occur equivalently in men and women.…”

How to manage persistent hiccups in patients undergoing mechanical ventilation?

“…The main purpose of treatment of persistent hiccups is to stop involuntary spasms of the diaphragm. Unfortunately, there are no guidelines available to help effectively treatment of this serious disorder 9 . Treatment of persistent hiccups during mechanical ventilation involves five parts.…”