Postoperative opisthotonus and torticollis after fentanyl, enfiurane, and nitrous oxide

Dehring, Deborah J.; Gupta, B. K.; Peruzzi, William T.

doi:10.1007/bf03036975

Cited by 21 publications

(6 citation statements)

References 36 publications

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“…reversing the opisthotonus in one instance. 17 In the event of encountering these phenomena, it has been recommended that therapy be aimed at potentiating the inhibitory neurotransmitters glycine and y-aminobutyric acid (GABA) using benzodiazepines, physostigmine, and chlormethiazole. 16 …”

Section: Discussionmentioning

confidence: 99%

Prolonged myoclonus and meningism following propofol

Hughes

Lyons

1995

Can J Anaesth

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Accepted for publication 5th April, 1995. Propofol was introduced into clinical practice in 1986, and since then has been given to over 16 million patients worldwide (data provided by Zeneea formerly ICI Pharma). The incidence of adverse effects has been low and confined mainly to excitatory neurological manifestations. Increased use, however, has unveiled a broadening spectrum of such phenomena, and here we describe the fLrst case of meningism occurring in association with propofol administration.Case report A 15-yr-old boy, weighing 52 kg, presented for removal of dental wires under general anaesthesia. These had been inserted five weeks previously for fixation of a fractured mandible, and on that occasion anaesthesia (O2:N20: isoflurane following induction with thiopentone) had been uneventful. The patient had no previous medical history, and had not sustained a head injury or loss of consciousness when fracturing his mandible. There was no history of epilepsy, drug abuse or recent infections.The patient presented as a day case and was unpremedicated. On arrival in theatre intravenous access was established and 50 Isg of fentanyl were given. Monitoring consisted of non-invasive blood pressure measurement, ECG, and pulse oximetry. After pre-oxygenafion, anaesthesia was induced with propofol 175 nag, and this was not accompanied by excitatory phenomena or pain on injection. The dental wires were quickly removed (one minute), and no further anaesthetic agents were administered. On resumption of spontaneous ventilation the patient was brought to the recovery room where five minutes alter induction of anaesthesia he developed generalised myoclonic jerking. These spasmodic contractions were asynchronous in nature, involved the muscles of his arms, trunk and legs, and were exacerbated by attempts to rouse him. He remained unresponsive and was noted to have a marked disconjugate gaze and pupillary dilatation. This state persisted for 35 min and during this time temperature, blood pressure, heart rate, arterial blood gas, and blood glucose measurements were within normal limits. Then the patient regained conseiousness but there was no improvement in the myoclonus. Diazemuls, 5 mg/v, was administered with minimal effect on the myoclonic jerking.

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Section: Discussionmentioning

confidence: 99%

Prolonged myoclonus and meningism following propofol

Hughes

Lyons

1995

Can J Anaesth

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“…It is characterized by muscular spasms causing an extreme hyperextension of the spine in which the head, back, and heels are bent backward, in some cases lifting the patient several inches off of the examination table (1)(2)(3). Etiologies include, but are not limited to, various anesthetic agents, meningeal irritation, post-meningitic sequelae, water intoxication, certain congenital neurologic malformations, acute caffeine intoxication in neonates, and tetanus (1)(2)(3)(4)(5)(6)(7)(8). Cocaine has not been reported as a potential etiology for opisthotonus based upon our MEDLINE search.…”

Section: Discussionmentioning

confidence: 99%

Opisthotonus in Neurosyphilis: A Case Report

Chauhan

Pickens

2011

The Journal of Emergency Medicine

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“…In the literature, abnormal fentanyl-induced movements have rarely been encountered with the use of the drug. The manifestations of fentanyl use include but are not limited to: chest wall rigidity, seizure-like activity with normal electroencephalograms, tremors, ataxia, choreoathetosis, opisthotonus, and torticollis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Exemplary reactions were observed exclusively with high doses of opioids, one of them being fentanyl, for prolonged periods of use [ 8 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Opioid-Induced Myoclonic Reaction after Use of Fentanyl as an Anesthetic Drug for an Emergency Cesarean Section

2018

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Myoclonus is an abnormal involuntary movement that has been previously reported with administration of high doses of opioids for prolonged periods of time. In this case, however, we report an acute myoclonic reaction and review the literature on the possible causative pathophysiology. We report the case of a 24-year-old woman who was admitted for postdated cesarean section. She started to have abnormal involuntary movements after administration of an epidural anesthesia containing 700 μg of fentanyl with 115 mL (0.5) bupivacaine and 40 mL (2%) lidocaine. Upon examination, the patient was conscious, alert, and oriented. Her vital signs were stable. Her movements can be described as generalized, sudden, involuntary, jerking movements, involving the upper limbs, head, torso as well as the lower limbs. The frequency of these jerks was about every 1–2 min lasting for 10 s. There was no change in level of consciousness during these abnormal movements. The rest of the neurological examination was normal. Laboratory values showed normoglycemia and normal serum biochemistry. A routine electroencephalogram showed no epileptiform activity. Brain imaging was normal. Based on history, examination, and laboratory findings, we made the diagnosis of drug-induced myoclonus, which in this clinical scenario was secondary to fentanyl. We discontinued fentanyl and, gradually, the intensity and frequency of the abnormal movements decreased and disappeared after a few hours. A clear definitive explanation of the acute effect of opioids is still to be reached. It involves an interaction of complex neuroanatomical pathways and neurophysiological receptors. Nonetheless, a unanimous effort is needed to raise awareness about the role of opioids in the development of abnormal movements and their clinical management, to insure that they do not go unnoticed in the clinical scenarios, and to further add more scientific content that could help in reaching an explanatory theory.

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Postoperative opisthotonus and torticollis after fentanyl, enfiurane, and nitrous oxide

Cited by 21 publications

References 36 publications

Prolonged myoclonus and meningism following propofol

Prolonged myoclonus and meningism following propofol

Opisthotonus in Neurosyphilis: A Case Report

Acute Opioid-Induced Myoclonic Reaction after Use of Fentanyl as an Anesthetic Drug for an Emergency Cesarean Section

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