Propofol Associated Hiccups and Treatment with Lidocaine

Landers, Cheri; Turner, Dawn; Makin, Carrie; Zaglul, Horacio; Brown, Raeford E.

doi:10.1213/ane.0b013e3181853605

Cited by 21 publications

(10 citation statements)

References 5 publications

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“…The pathophysiology of gastroesophageal reflux in most also been reported to be associated with hiccup, and being successfully treated with lidocaine [18]. While propofol is routinely used in all age groups, we don't frequently encounter this complication probably because lidocaine is almost routinely administered prior to propofol to prevent pain on injection with propofol [20]. 4.…”

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

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Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Mathew

Shen

Liu

2019

Transl Perioper & Pain Med

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Hiccup is an involuntary contraction of the diaphragm and intercostal muscles resulting in sudden inspiration and closure of the glottis. The presence of hiccup in the perioperative period can be a challenging problem. Sudden movements of the patient from hiccups can interfere preoperative diagnostic procedures, intraoperative hiccup may delay the beginning of surgery, interfere with the surgical process, and affect intraoperative monitoring, and postoperative hiccup may affect would healing and hemodynamic stability. Hiccup can lead to have increased aspiration risk. Hiccup are is an incompletely understood phenomenon with multiple etiologies. Intraoperative hiccup related to laryngeal mask airway placement has been reported, and it presents unique challenges in diagnosis and management. Both pharmacological and non-pharmacological interventions have been utilized with various level of success. All treatment strategies are primarily aimed at interrupting the hiccup reflex arc.

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Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

“…Inadequate seal of the mask either due to poor technique or patient related factors can lead to inadvertent gastric insufflation. This can cause over distension of the stomach and is suggested to cause intraoperative hiccups [20].…”

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Mathew

Shen

Liu

2019

Transl Perioper & Pain Med

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“…Lidocaine can stabilize cell membrane by blocking sodium channels to reduce neuronal excitability. It has been used successfully in treating or pre-treating intractable hiccups induced via many measures 57,66,67. Other miscellaneous agents used to treat hiccup include calcium channel blockers and antidepressants 8…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

161

173

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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.

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“…A previous case report of propofolrelated hiccups described laryngospasm and hiccups in a child almost immediately after drug administration during some (but not all) of her propofol sedation events. 16 Propofol is an unlikely cause of hiccups in our case because it was administered only once during anesthesia induction and pharmacokinetic studies of propofol in term neonates demonstrate drug clearance values that do not support continued pharmacologic presence of propofol beyond 24 hours after drug administration. 19 Perhaps a stronger argument could be made with the concomitant analgesic fentanyl, because every time the dose of ropivacaine was changed, so too was the dose of fentanyl.…”

Section: Discussionmentioning

confidence: 75%