Singultus, paper-bag ventilation, and hypercapnia

Petroianu, Georg

doi:10.1080/0964704x.2019.1708161

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…More contributory to the understanding of the pathophysiology is a look at therapies empirically established for the suppression of the so-called occasional or transient hiccup. These have recently been reviewed, and the author concludes that the common denominator of most, if not all of these homegrown remedies is their ability to activate the vagus nerve, as evidenced by their additional ability to terminate paroxysmal supraventricular tachycardias ( Petroianu, 2013 , 2015 , 2020 ). Among the best-known “vagal maneuvers” are the oculo-cardiac reflex (Dagnini-Aschner), carotid sinus massage, the Valsalva maneuver, and ice ingestion.…”

Section: Introductionmentioning

confidence: 99%

The Role of Serotonin in Singultus: A Review

Petroianu

Lorke

2020

Front. Neurosci.

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The use of dopamine receptor blockers for chronic singultus treatment is basedat least partially-on circular thinking: chlorpromazine is FDA-approved for hiccups, chlorpromazine is a neuroleptic, neuroleptics are dopamine receptor blockers, and therefore hiccup is due to dopaminergic dysfunction. Chlorpromazine interacts with high affinity with a multitude of receptors and ion channels. This promiscuity is the basis for many of the therapeutic effects and adverse drug reactions of this drug. While an involvement of dopamine is certain, it is by no means clear that dopaminergic dysfunction is the hallmark of singultus. The common denominator of most remedies for transient hiccup is their ability to activate the vagus nerve. Both afferent and efferent vagal activity and the central integration of the Xth cranial nerve function are modulated, inter alia, via serotonergic mechanisms; beneficial (therapeutic) effects for hiccup are to be expected from serotonin (5-HT) receptor subtype ligands that enhance vagal activity. Taken together, it appears that the ability to increase vagus output is mainly associated with 5-HT 1A , 5-HT 3 , and 5-HT 7 agonists and with 5-HT 2C antagonists. The plausibility of the serotonergic singultus hypothesis is examined against available pharmacokinetic, pharmacodynamic, and clinical data for a number of drugs.

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Section: Introductionmentioning

confidence: 99%

The Role of Serotonin in Singultus: A Review

Petroianu

Lorke

2020

Front. Neurosci.

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“…Sudden contraction of the diaphragm generates strong negative pressure in the air tract, and air aspirated through the narrow space between the vocal cords as they slam shut creates the high-pitch 'hic' noise we know as a hiccup (3,4). Although the nature of singultus is still a mystery (3,4), it has been believed since ancient times that CO 2 retention in the body should lead singultus to stop (7). In fact, many researchers have studied about it using paper-bag rebreathing and CO 2 inhalation; CO 2 affects the central nervous system (CNS) and ceases singultus, although the precise mechanism has not been completely revealed as of yet (5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

“…Although the nature of singultus is still a mystery (3,4), it has been believed since ancient times that CO 2 retention in the body should lead singultus to stop (7). In fact, many researchers have studied about it using paper-bag rebreathing and CO 2 inhalation; CO 2 affects the central nervous system (CNS) and ceases singultus, although the precise mechanism has not been completely revealed as of yet (5)(6)(7)(8). According to historical evidence, it is thought that CO 2 has some potential to cut the circuit of singultus in the CNS (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…In fact, many researchers have studied about it using paper-bag rebreathing and CO 2 inhalation; CO 2 affects the central nervous system (CNS) and ceases singultus, although the precise mechanism has not been completely revealed as of yet (5)(6)(7)(8). According to historical evidence, it is thought that CO 2 has some potential to cut the circuit of singultus in the CNS (7,8). On this ground, treatment using CO 2 would possibly be a radical therapy for singultus (7).…”

Section: Discussionmentioning

confidence: 99%

“…According to historical evidence, it is thought that CO 2 has some potential to cut the circuit of singultus in the CNS (7,8). On this ground, treatment using CO 2 would possibly be a radical therapy for singultus (7). Unfortunately, however, methods such as paper-bag rebreathing are still considered to be home remedies, even now (4,6).…”

Section: Discussionmentioning

confidence: 99%

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Preliminary experimental outcomes of induced hypercapnia in treatment of obstinate singultus

Obuchi

Makimoto

Iwasaki³

2020

J Thorac Dis

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Background: Our team found that abolishing the venous-arterial CO 2 gradient can cease singultus (hiccups), in which the CO 2 pressure in blood reaches no less than 50 mmHg. In order to precisely investigate the target level as a preliminary study, we made a combination gas consisting of 10% CO 2 and 90% O 2 to generate the conditions instantly and safely.Methods: Thirty-five cases consisting of 26 patients with long-term chronic singultus were treated using the gas. The group consisted of 21 males and 5 females with mean singultus duration of 8.0±13.1 years.A standard oxygen mask was used for delivery of the gas to the patients, and patients breathed in the gas until they felt relief. The duration of the procedure was measured from the beginning to the point at which singultus ceased. A blood test was performed to measure the partial pressure of CO 2 in venous blood at the point at which singultus ceased.Results: Singultus ceased in all patients in a mean time of 5.3±1.5 minutes, with complete recurrence observed in two cases. The mean partial pressure of CO 2 in the venous blood at the point the singultus stopped was 60.8±6.8 mmHg. No life-threatening complications were found in any patient.Conclusions: One of the definitive conditions for ceasing singultus is acute CO 2 retention in the body, the target of which is around 60 mmHg of CO 2 in venous blood. We believe that targeting acute hypercapnia can always stop singultus, although further neuroscientific investigation is necessary to reveal the physiological mechanism.

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Hiccups are a manifestation of central respiratory arrhythmias

Bacak,

Danner

2023

Medical Hypotheses

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Singultus, paper-bag ventilation, and hypercapnia

Cited by 5 publications

References 24 publications

The Role of Serotonin in Singultus: A Review

The Role of Serotonin in Singultus: A Review

Preliminary experimental outcomes of induced hypercapnia in treatment of obstinate singultus

Hiccups are a manifestation of central respiratory arrhythmias

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