51
|
Tolosa E, Coelho M, Gallardo M. DAT imaging in drug-induced and psychogenic parkinsonism. Mov Disord 2004; 18 Suppl 7:S28-33. [PMID: 14531043 DOI: 10.1002/mds.10575] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Parkinson's syndrome (PS) is frequently encountered in disorders associated with prominent degeneration of the nigrostriatal pathway as in Parkinson's disease, multisystem atrophy, and progressive supranuclear palsy (presynaptic PS). Drug-induced parkinsonism, a common, underdiagnosed health problem and psychogenic parkinsonism are causes of Parkinson's syndrome which, evidence suggests, occurs without degeneration of nigrostriatal structures. We review clinical features and results of DAT imaging in drug-induced parkinsonism and psychogenic parkinsonism. These two conditions normally give normal striatal DAT imaging results; an abnormal result in either case could exclude both conditions, corroborating a diagnosis of organic parkinsonism in uncertain cases.
Collapse
Affiliation(s)
- Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut Clinic Malaltias del Sistema Nervios, Hospital Clínic Universitari, University of Barcelona, Spain.
| | | | | |
Collapse
|
52
|
Abstract
Myoclonus is a sudden, abrupt, brief, 'shock-like' involuntary movement caused by muscular contractions ('positive myoclonus') or a sudden brief lapse of muscle contraction in active postural muscles ('negative myoclonus' or 'asterixis'). Various disorders can cause myoclonus including neurodegenerative and systemic metabolic disorders and CNS infections. In addition, myoclonus has been described as an adverse effect of some drugs. Level II evidence is available to indicate that levodopa, cyclic antidepressants and bismuth salts can cause myoclonus, while there is less robust evidence to associate numerous other drugs with the induction of myoclonus. The pharmacological mechanisms responsible for this adverse effect are not well established, although increased serotonergic transmission may be involved in the induction of myoclonus by several drugs. Drug-induced myoclonus usually resolves after withdrawal of the offending drug, but in some cases specific treatments are needed.
Collapse
Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Department of Medicine - Neurology, Hospital "Príncipe de Asturias", Universidad de Alcalá, Alcalá de Henares, Madrid, SpainNeuro-Magister S.L. Company, Madrid, Spain.
| | | | | |
Collapse
|
53
|
Bogey RA, Elovic EP, Bryant PR, Geis CC, Moroz A, O'Neill BJ. Rehabilitation of movement disorders11A commercial party with a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or one or more of the authors. Elovic is on the advisory board and speaker’s bureau of Allergan. Arch Phys Med Rehabil 2004; 85:S41-5. [PMID: 15034854 DOI: 10.1053/j.apmr.2003.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED This self-directed learning module highlights several movement disorders. These include dystonia, chorea, tremors, and myoclonus. A description of the clinical presentation and associated disease processes is presented. Although the discussion on treatment focuses on pharmacologic intervention, surgical options are presented when appropriate. Other movement disorders (ie, parkinsonism) are discussed elsewhere in the Study Guide. OVERALL ARTICLE OBJECTIVES (a) To define the various symptoms and etiologies of dystonia; (b) to define chorea and its treatment; (c) to define tremors, including associated neurologic disorders, plus pharmacologic and potential surgical interventions; and (d) to describe the symptoms, classification, and treatment of primary and secondary myoclonus.
Collapse
Affiliation(s)
- Ross A Bogey
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, IL 60611, USA.
| | | | | | | | | | | |
Collapse
|
54
|
Abstract
The main clinical characteristics and aetiology of drug-induced tremor and acute movement disorders (myoclonus, chorea, athetosis, dyskinesia, dystonia, tics) are reviewed and discussed in this article. Tremor is the most frequent drug-induced acute movement disorder. Drug intake (and, initially, true or 'hidden' neuroleptic or psychoactive drugs) should be suspected as the cause of every abnormal movement. Drug-induced acute movement disorders usually disappear spontaneously after withdrawal of the suspected drug without any drug treatment. Drug-induced tremor and movement disorders are often poorly described in the Summary of Products Characteristics (SPC).
Collapse
|
55
|
Macfarlane TV, Blinkhorn AS, Davies RM, Worthington HV. Association between local mechanical factors and orofacial pain: survey in the community. J Dent 2003; 31:535-42. [PMID: 14554070 DOI: 10.1016/s0300-5712(03)00108-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aetiology of orofacial pain (OFP) is not well understood. We aimed to determine the relationship between OFP and local mechanical factors in an unselected general population sample. METHODS A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (adjusted participation rate 74%). Postal questionnaire was used to collect information on OFP and local mechanical factors. RESULTS A significant association was found between OFP and a history of tooth grinding, facial trauma, the jaw getting stuck or locked, a clicking or grating sound in the jaw joint when opening or closing the mouth, difficulty in opening the mouth wide, and chewing of pens or biting finger nails. The jaw getting stuck or locked had the highest relative risk of 2.7 (95% CI: 2.3-3.2). A history of orthodontic treatment, having any type of dentures and using chewing gum were not associated with OFP. There was some evidence of heterogeneity between types of OFP and local mechanical factors. CONCLUSIONS Local factors play an important role in the aetiology of OFP.
Collapse
Affiliation(s)
- T V Macfarlane
- Turner Dental School, The University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.
| | | | | | | |
Collapse
|
56
|
Ohno K, Miyazawa S, Hashiguchi M, Unemoto T, Itoh A, Echizen H, Rikihisa T, Ogata H, Murata M. Establishing a Comprehensive Questionnaire for Detecting Drug-induced Extrapyramidal Symptoms. YAKUGAKU ZASSHI 2003; 123:881-6. [PMID: 14577334 DOI: 10.1248/yakushi.123.881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Drug-induced extrapyramidal symptoms (DIEPS) often substantially compromise quality of life (QOL) of patients receiving drugs with central antidopaminergic activities. A lack of comprehensive screening method based upon patients' subjective symptoms for detecting DIEPS appears to have prevented pharmacists from delivering satisfactory pharmaceutical care for these patients. Thus, we have attempted to develop a comprehensive questionnaire for screening patients having higher risks of developing DIEPS. METHODS One hundred fourteen outpatients taking gastroprokinetic drugs (itopride, cisapride, trimebutine, domperidone and metoclopramide) at least 2 weeks participated in the study. One patient with familial Parkinson disease served as a positive reference. They undertook a questionnaire consisting of 9 comprehensive questions written in non-technical words that were aimed to detect typical symptoms of Parkinsonism including akathisia and dyskinesia. Each symptom was scored in a semiquantitative scale [i.e., from 1 (not at all) to 5 (very much)] by the patients. RESULTS Of the 108 subjects who successfully completed the questionnaires, 43 gave scores 2 or greater indicating the presence of DIEPS. However, no statistically significant correlations were observed between the scores of any possible pairs of the questionnaire items. Five subjects had a mean questionnaire score of equal to or greater than 1.6, and the patient with familiar Parkinsonism had the highest mean score of 1.9. CONCLUSION The questionnaire presented herein detected 4 patients with suspected DIEPS. Further studies should be warranted to assess whether it would be useful for pharmacists as a screening tool for DIEPS in patients having higher risks of DIEPS.
Collapse
Affiliation(s)
- Keiko Ohno
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
57
|
Abstract
Anticonvulsant-induced dyskinesia (AID) is an underdiagnosed side effect of many anticonvulsants that may take place during initial or chronic treatment at normal or toxic drug levels. The occurrence of AID subjects the patient to another medical condition and may prompt an extensive work-up. Similarities with other drug-induced dyskinesias and some animal studies suggest that dopaminergic dysfunction in the basal ganglia is pivotal in the occurrence of dyskinesia. Clinical presentation and outcomes are variable; however, in most cases, dyskinesias respond well to anticonvulsant withdrawal. Enhancing the awareness of AID is important in light of the recent development of many new anticonvulsants and their wider clinical use.
Collapse
Affiliation(s)
- Megdad M Zaatreh
- University of North Carolina, Department of Neurology, 3114 Bioinformatics, CB#7025, Chapel Hill, NC 27599-7025, USA.
| |
Collapse
|
58
|
Benito-León J, Bermejo-Pareja F, Rodríguez J, Molina JA, Gabriel R, Morales JM. Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003; 18:267-274. [PMID: 12621629 DOI: 10.1002/mds.10362] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The prevalence of Parkinson's disease (PD) and other types of parkinsonism in three elderly populations of central Spain was investigated using a door-to-door, two-phase approach. This design called for the administration of a brief questionnaire to subjects 65 years of age or older taken from the census of one urban municipality of Greater Madrid (Margaritas, Getafe), one rural site (Arévalo County, Avila), and one urban district of Madrid (Lista) in Spain (N = 5,278). Study neurologists extensively investigated those subjects who screened positively. The diagnoses, based on specified criteria, were reviewed to increase reliability across neurologists. We found 118 subjects with parkinsonism: 81 affected by PD (68.6%), 26 drug-induced parkinsonism (22.0%), 6 parkinsonism in dementia (5.1%), 3 vascular parkinsonism (2.5%), and 2 unspecified parkinsonism (1.7%). The prevalence was 2.2% (95% confidence interval [CI], 1.8-2.6) for all types of parkinsonism and 1.5% (95% CI, 1.2-1.8) for PD. The prevalence estimates of parkinsonism and PD increased with age, declining at 85 years and over. Age prevalence ratios were higher for men. Twenty-three subjects (28.4%) of the subjects with PD were detected through the screening and had not been diagnosed previously. Overall prevalence estimates of PD and other types of parkinsonism in central Spain rank at levels similar to those recently reported for other European and non-European elderly populations. Despite improvement in access to health services, an important proportion of PD patients may never seek neurological attention.
Collapse
Affiliation(s)
- Julián Benito-León
- Department of Neurology, Móstoles General Hospital, Móstoles, Madrid, Spain
| | | | - Javier Rodríguez
- Department of Neurology, Nuestra Sra. del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | | | - Rafael Gabriel
- Department of Epidemiology, University Hospital La Princesa, Madrid, Spain
| | | |
Collapse
|
59
|
|
60
|
Abstract
BACKGROUND Drug-induced parkinsonism is common but often unrecognized. In addition to neuroleptics, many medications of diverse chemical nature may induce or exacerbate parkinsonism REVIEW SUMMARY Reports in the literature of drug-induced parkinsonism or of an underlying parkinsonian disorder exacerbated by a medication were located using MEDLINE, and pertinent bibliographies were reviewed. The range of medications that may induce or exacerbate parkinsonism spans the medical specialties. Along with neuroleptics, selective-serotonin reuptake inhibitors, lithium, valproic acid, calcium channel blockers, antiarrhythmics, procholinergics, chemotherapeutics, amphotericin B, estrogens, and others have been implicated. CONCLUSIONS This review seeks to enhance clinicians' knowledge of potential medications producing iatrogenic parkinsonism and encourage their vigilance in recognizing it.
Collapse
Affiliation(s)
- J A Van Gerpen
- Department of Neurology, Section of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
| |
Collapse
|
61
|
Thomsen TW, Brown DFM, Nadel ES. Pediatric tremors. J Emerg Med 2002; 23:75-8. [PMID: 12217475 DOI: 10.1016/s0736-4679(02)00470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Todd W Thomsen
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts 02114, USA
| | | | | |
Collapse
|
62
|
Affiliation(s)
- Hiroko Akagi
- Department of Liaison Psychiatry, St James's University Hospital, Leeds LS9 7TF.
| | | |
Collapse
|
63
|
Tzeng JI, Hsing CH, Chu CC, Chen YH, Wang JJ. Low-dose dexamethasone reduces nausea and vomiting after epidural morphine: a comparison of metoclopramide with saline. J Clin Anesth 2002; 14:19-23. [PMID: 11880017 DOI: 10.1016/s0952-8180(01)00345-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare the efficacy of a low dose of dexamethasone (5 mg) with metoclopramide 10 mg and saline in preventing nausea and vomiting after epidural morphine in posthysterectomy analgesia. DESIGN Randomized, placebo-controlled study. SETTING Inpatient surgery at Municipal Women's and Children's General Hospital. PATIENTS 120 ASA physical status I and II women receiving epidural morphine for posthysterectomy analgesia. INTERVENTIONS All patients received epidural morphine 3 mg for postoperative analgesia. The dexamethasone group (n = 40) received dexamethasone 5 mg, the metoclopramide group (n = 40) received metoclopramide 10 mg, and the saline group (n = 40) received saline. MEASUREMENTS AND MAIN RESULTS The occurrence of nausea and vomiting appeared more frequently during 6 to 24 hours following the administration of epidural morphine. The total frequency of nausea and vomiting in the dexamethasone group was significantly lower than that of the metoclopramide and saline groups during this period, with reporting frequencies of 21%, 49%, and 53%, respectively (p <.05 each). However, the difference between metoclopramide and saline did not reach statistical significance. CONCLUSIONS Dexamethasone 5 mg was more effective than metoclopramide or saline in the prevention of nausea and vomiting associated with epidural morphine for postoperative analgesia.
Collapse
Affiliation(s)
- Jann Inn Tzeng
- Department of Anesthesiology, Municipal Women's and Children's General Hospital, Kaohsiung
| | | | | | | | | |
Collapse
|
64
|
Abstract
OBJECTIVE To report a case of acute dystonia consisting of neck stiffness, trismus, and unilateral temporomandibular joint (TMJ) pain and subluxation secondary to an increase in sustained-release (SR) bupropion. CASE SUMMARY A 44-year-old white man with a history of chronic low-back pain and tension headaches, taking no other medications, was started on bupropion SR 150 mg once a day for depression. The dosage was increased to 150 mg SR twice a day and eventually augmented with buspirone 15 mg 3 times a day. He developed bilateral trismus, inability to rotate his head laterally, and spontaneous left TMJ subluxation. Symptoms recessed with discontinuation of both medications and failed to reappear with a trial of buspirone 15 mg 3 times a day alone. A retrial of bupropion alone evidenced no adverse effects at a dosage of 150 mg SR once a day. However, when the dosage was increased to 150 mg SR twice a day, the patient reexperienced initial signs of neck stiffness, jaw muscle tightness, and left TMJ subluxation within 24-48 hours. Reduction of the bupropion dosage to 150 mg SR once daily stopped the symptoms; the patient has continued at this dosage without adverse effects for > 1 year. DISCUSSION Medication-induced focal dystonias usually present with dramatic head (most frequently oral-buccal) and neck muscle spasm with occasional jaw clenching, bruxism, and TMJ syndrome. In this case, the rapid onset of neck and jaw symptoms within 24-48 hours of an increase of bupropion SR from 150 mg once a day to 150 mg twice a day suggest that the patient may have been sensitized by an initial trial of bupropion and buspirone, or by the increased dose of bupropion alone. Both agents are reported to interact with both the dopaminergic and serotonergic systems. Although buspirone has been implicated in inducing acute dystonia, it did not do so in this case when used alone at a dose of 45 mg a day. During a second trial of bupropion SR 150 mg a day, neck and jaw symptoms recurred within 24-48 hours of increasing the dose to 150 mg SR twice a day. The symptoms receded when the bupropion dose was returned to 150 mg SR once a day, suggesting a dose-response relationship. The Naranjo probability scale indicated that this untoward reaction was probable. CONCLUSIONS This case suggests that selected patients may experience dose-related acute dystonic adverse reactions to bupropion with or without buspirone augmentation. Dystonias, which usually follow administration of antipsychotics, have been linked to acute dopamine depletion and basal ganglion-derived gamma synchronization dysfunction. Acute dystonia symptoms may begin within hours of starting or changing antipsychotic drug dosage; however, 90% of symptoms are observed during the first 3-5 days of starting or increasing dosage. To the best of our knowledge, there have been no reports of bupropion-induced dystonia.
Collapse
Affiliation(s)
- Mark B Detweiler
- Department of Psychiatric Medicine (116A7), Salem Veterans Affairs Medical Center, University of Virginia, Salem-Roanoke, 1970 Roanoke Blvd., Salem, VA 24153-6478, USA.
| | | |
Collapse
|
65
|
Ghaziuddin N, Iqbal A, Khetarpal S. Myoclonus during prolonged treatment with sertraline in an adolescent patient. J Child Adolesc Psychopharmacol 2002; 11:199-202. [PMID: 11436961 DOI: 10.1089/104454601750284126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 15-year-old female adolescent with depression developed myoclonus after uninterrupted treatment with sertraline over 6 years. She was also receiving methylphenidate. Withdrawal of sertraline and continuation of methylphenidate did not result in any improvement. Treatment with valproic acid resulted in improvement of the movement disorder. This report suggests that myoclonus may be a side effect of sertraline in some adolescents. Further, we hypothesized that extended treatment over several years, young age, and a compromised central nervous system due to underlying disorders may be risk factors for the development of this side effect.
Collapse
Affiliation(s)
- N Ghaziuddin
- Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor 48109-0390, USA.
| | | | | |
Collapse
|
66
|
Huang JC, Shieh JP, Tang CS, Tzeng JI, Chu KS, Wang JJ. Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery. Can J Anaesth 2001; 48:973-7. [PMID: 11698315 DOI: 10.1007/bf03016586] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the prophylactic effect of low-dose dexamethasone (5 mg) on postoperative nausea and vomiting (PONV) in women undergoing ambulatory laparoscopic surgery. Metoclopramide and saline served as controls. METHODS One hundred twenty women (n=40 in each of the three groups) undergoing ambulatory laparoscopic tubal ligation under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. After tracheal intubation, group I received i.v. dexamethasone 5 mg, whereas groups II and III received i.v. metoclopramide 10 mg and saline, respectively. RESULTS Patients in group I reported a lower incidence of PONV and requested less rescue antiemetics than those in group III during the first four postoperative hours (P <0.01). Patients in group I reported a lower incidence of PONV than those in groups II (P <0.05) and III (P <0.01) during the 24-hr postoperative period. Groups II and III did not differ from each other in the incidence of PONV and the proportion of patients who requested rescue antiemetics. CONCLUSION Prophylactic iv dexamethasone 5 mg significantly reduces the incidence of PONV in women undergoing ambulatory laparoscopic tubal ligation. At this dose, dexamethasone is more effective than metoclopramide 10 mg or placebo.
Collapse
Affiliation(s)
- J C Huang
- Department of Medical Research, and Anesthesiology, Chi-Mei Medical Center, Tainan. Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
67
|
Abstract
This article defines myoclonus, describes the numerous causes of myoclonus, and summarizes various classification schemes. The electrodiagnostic characteristics and pathophysiology of this movement disorder are described. Treatment of the various forms of myoclonus is also discussed.
Collapse
Affiliation(s)
- K Blindauer
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| |
Collapse
|
68
|
Liu YH, Li MJ, Wang PC, Ho ST, Chang CF, Ho CM, Wang JJ. Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery. Laryngoscope 2001; 111:1271-4. [PMID: 11568553 DOI: 10.1097/00005537-200107000-00024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prophylactic effect of dexamethasone on postoperative nausea and vomiting (PONV) in patients undergoing tympanomastoid surgery. STUDY DESIGN Eighty patients (n = 40 in each of two groups) undergoing tympanomastoid surgery under general anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. METHODS After tracheal intubation, group 1 received 10 mg dexamethasone intravenously, whereas group 2 received saline intravenously. Several parameters concerning with the occurrence of PONV were evaluated. RESULTS We found that dexamethasone reduced the total incidence of nausea and vomiting by 45%, with a 95% confidence interval of 26% to 64% (P <.001). Furthermore, dexamethasone reduced the incidence of vomiting episodes >4 times and the incidence of patients requiring rescue antiemetics (P <.05). CONCLUSION Dexamethasone at a dosage of 10 mg administered intravenously is effective in preventing PONV in patients undergoing tympanomastoid surgery.
Collapse
Affiliation(s)
- Y H Liu
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
69
|
Ho ST, Wang JJ, Tzeng JI, Liu HS, Ger LP, Liaw WJ. Dexamethasone for Preventing Nausea and Vomiting Associated with Epidural Morphine: A Dose-Ranging Study. Anesth Analg 2001. [DOI: 10.1213/00000539-200103000-00036] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
70
|
Ho ST, Wang JJ, Tzeng JI, Liu HS, Ger LP, Liaw WJ. Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study. Anesth Analg 2001; 92:745-8. [PMID: 11226112 DOI: 10.1097/00000539-200103000-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. Two hundred twenty-five women (n = 45 in each of the five groups) undergoing simple abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. When the incision closure was completed, patients received IV dexamethasone, 10 mg, 5 mg, or 2.5 mg; IV droperidol 1.25 mg; or saline 2 mL. All patients received epidural morphine 3 mg for postoperative analgesia. We found that patients who received dexamethasone 5 mg or 10 mg or droperidol 1.25 mg were significantly different from those who received saline alone in the following variables: the total incidence of nausea and vomiting, the incidence of more than four vomiting episodes, the number of patients requiring rescue antiemetics, the total number of patients with no vomiting and/or no antiemetic medication (P < 0.05 to P < 0.01). The differences among dexamethasone 10 mg and 5 mg and droperidol 1.25 mg were not significant. Dexamethasone 2.5 mg was ineffective. In conclusion, because dexamethasone 5 mg was as effective as 10 mg as an antiemetic, we recommend the smaller dose for preventing nausea and vomiting associated with epidural morphine. IMPLICATIONS We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. We found that dexamethasone 5 mg was as effective as 10 mg. We recommend the smaller dose for this purpose.
Collapse
Affiliation(s)
- S T Ho
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei.
| | | | | | | | | | | |
Collapse
|
71
|
James LP, Abel K, Wilkinson J, Simpson PM, Nichols MH. Phenothiazine, butyrophenone, and other psychotropic medication poisonings in children and adolescents. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 2001; 38:615-23. [PMID: 11185968 DOI: 10.1081/clt-100102010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the presentation, epidemiology, management, and outcome of phenothiazine and butyrophenone ingestions in children requiring hospitalization. METHOD Retrospective case series in two pediatric hospitals. RESULTS Eighty-six cases were identified among 83 patients. The majority (69.7%) of ingestions occurred in children <6 years of age and there was no gender predominance. These ingestions were more common in African Americans (65.1%). They occurred more commonly in the patient's (64.0%) or a relative's (22.1%) home and haloperidol and thioridazine accounted for 58.1% of exposures. Depressed levels of consciousness and dystonia were the most common presenting signs, present in 90.7% and 51.2% of patients, respectively. Miosis occurred in only 13.9% of the patients. Fluid boluses were administered to 28.7% of the patients but about a quarter of these had coingested potentially cardiotoxic drugs. In addition, 2 of the 12 (13.9%) patients with abnormal electrocardiograms had also ingested potentially cardiotoxic drugs. Numerous diagnostic tests were performed in these patients including electrolyte panels (80.2%), complete blood counts (69.8%), liver function tests (31.4%), serum osmolality (20.9%), blood cultures (10.5%), lumbar punctures (17.4%), head computed tomographies (15.1%), and electroencephalograms (3.5%). The median length of hospitalization was 1.78 (range 1-9) days and there were no deaths. Patients presenting with dystonias were more likely to have extensive diagnostic testing for neurologic disease than those presenting without dystonias. CONCLUSION The presentation of phenothiazine and butyrophenone ingestions in children and adolescents may be nonspecific and confounded by coingestants. Patients with dystonias had more extensive neurologic testing than patients without dystonias, suggesting that physicians may not recognize dystonias as a clinical finding characteristic of phenothiazine or butyrophenone exposure.
Collapse
Affiliation(s)
- L P James
- Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock 72202, USA.
| | | | | | | | | |
Collapse
|
72
|
Wang JJ, Ho ST, Wong CS, Tzeng JI, Liu HS, Ger LP. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can J Anaesth 2001; 48:185-90. [PMID: 11220429 DOI: 10.1007/bf03019733] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the minimum effective dose of dexamethasone in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia. METHOD One hundred and eighty parturients (n=45 in each of four groups) requiring epidural morphine for post-Cesarean analgesia were enrolled in this randomized, double-blinded, placebo-controlled study. At the end of surgery, parturients received either dexamethasone, at doses of 10 mg, 5 mg, 2.5 mg, or saline i.v.. Three milligrams epidural morphine were given to all parturients for postoperative analgesia. The incidence of PONV and side effects were estimated for 24 hr after delivery by blinded, trained nurse anesthetists. RESULTS Parturients who received dexamethasone, either 10 mg or 5 mg were different from those who received saline alone in the following parameters: the total incidence of nausea and vomiting, incidence of > 4 vomiting episodes, number the of parturients requiring rescue antiemetics, and the total number of parturients with no vomiting and/or no antiemetic medication (P < 0.05 to P < 0.01). The differences between dexamethasone 10 mg and 5 mg were not significant. Dexamethasone 2.5 mg was partially effective. CONCLUSION Dexamethasone, 5 mg i.v., is suggested as the minimum effective dose in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia.
Collapse
Affiliation(s)
- J J Wang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
73
|
Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia: comparison of droperidol and saline. Br J Anaesth 2000; 85:865-8. [PMID: 11732521 DOI: 10.1093/bja/85.6.865] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have evaluated the prophylactic effect of i.v. dexamethasone 8 mg in preventing nausea and vomiting during epidural morphine for post-Caesarean section analgesia. Droperidol 1.25 mg and saline served as the control. We studied 120 parturients (n=40 in each group) receiving epidural morphine for post-Caesarean section analgesia, in a randomized, double-blind, placebo-controlled study. All parturients received epidural morphine 3 mg. Both dexamethasone and droperidol significantly decreased the total incidence of nausea and vomiting compared with saline, with incidences of 18, 21 and 51% for the three treatments respectively (P<0.01 and P<0.05 respectively). Parturients who received droperidol reported a more frequent incidence of restlessness (16%) than those who received dexamethasone (P<0.05).
Collapse
Affiliation(s)
- J I Tzeng
- Department of Anaesthesiology, School of Medicine, Kaohsiung Medical University, Taiwan
| | | | | | | | | | | |
Collapse
|
74
|
Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 2000; 91:1404-7. [PMID: 11093989 DOI: 10.1097/00000539-200012000-00019] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We sought to determine the minimum effective dose of dexamethasone in preventing postoperative nausea and vomiting in women undergoing thyroidectomy. Two hundred twenty-five women (n = 45 in each of five groups) undergoing thyroidectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Immediately after the induction of anesthesia, patients received IV dexamethasone at doses of 10 mg (D10), 5 mg (D5), 2.5 mg (D2.5), 1.25 mg (D1.25), or saline (S). We found that Groups D10 and D5 were significantly different from Group S in the total incidences of nausea and vomiting, more than four vomiting episodes, the proportions of patients requiring rescue antiemetics, and the incidences of complete responses. The differences between Groups D10 and D5 were not significant. Dexamethasone 2.5 mg reduced the total incidence of nausea and vomiting. Dexamethasone 1.25 mg was not effective. Dexamethasone 5 mg IV is the minimum effective dose in preventing postoperative nausea and vomiting in women undergoing thyroidectomy.
Collapse
Affiliation(s)
- J J Wang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
75
|
Feinberg JL, Tobias DE. MDS-Med Guide. Assessing medication effects using resident assessment data. Geriatr Nurs 2000; 21:291-7; quiz 298-9. [PMID: 11135126 DOI: 10.1067/mgn.2000.112142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The MDS-Med Guide is a unique new clinical tool developed to integrate patient assessment data with medication monitoring in the federally mandated resident assessment process. The guide correlates medication effects with a patient's physical, functional, and psychosocial status; identifies medications that may cause or aggravate common geriatric problems; and facilitates incorporation of medication information into the patient's care plan. The information provided in the guide is applicable to all geriatric patients receiving medication therapy to treat chronic diseases and conditions and should be of benefit to geriatric nurses in all practice settings.
Collapse
Affiliation(s)
- J L Feinberg
- American Society of Consultant Pharmacists Research and Education Foundation, Alexandria, Va., USA
| | | |
Collapse
|
76
|
Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, England, UK
| | | |
Collapse
|
77
|
Sawada Y, Nasu R, Matsuo H, Ohtani H. Relationship between structure and drug-induced parkinsonism. Ann Pharmacother 2000; 34:668. [PMID: 10852100 DOI: 10.1345/aph.19253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
78
|
Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The Prophylactic Effect of Dexamethasone on Postoperative Nausea and Vomiting in Women Undergoing Thyroidectomy. Anesth Analg 1999. [DOI: 10.1213/00000539-199907000-00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
79
|
Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 1999; 89:200-3. [PMID: 10389804 DOI: 10.1097/00000539-199907000-00036] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the prophylactic effect of dexamethasone on postoperative nausea and vomiting (PONV) in women undergoing thyroidectomy. Droperidol and saline served as controls. One hundred twenty women (n = 40 in each of three groups) undergoing thyroidectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Immediately before the induction of anesthesia, Group 1 received IV dexamethasone 10 mg, whereas Groups 2 and 3 received IV droperidol 1.25 mg and saline, respectively. We found that both dexamethasone and droperidol significantly decreased the total incidence of PONV compared with saline, with an incidence of 32%, 35%, and 76%, respectively (P<0.01; Group 1 versus Group 3, Group 2 versus Group 3). Patients who received droperidol, however, reported a higher intensity of sore throat and a more frequent incidence of restlessness than those who received dexamethasone. We conclude that, although both dexamethasone and droperidol are effective as prophylactic antiemetics in women undergoing thyroidectomy, droperidol produces more side effects. IMPLICATIONS We compared the prophylactic administration of dexamethasone to prevent nausea and vomiting with droperidol and saline in women undergoing thyroidectomy. Both dexamethasone and droperidol significantly reduced postoperative nausea and vomiting, but droperidol produced more side effects, which suggests that dexamethasone is a useful treatment in these patients.
Collapse
Affiliation(s)
- J J Wang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
80
|
Ortı́-Pareja M, Jiménez-Jiménez F, Vázquez A, Catalán M, Zurdo M, Burguera J, Martı́nez-Martı́n P, Molina J. Drug-induced tardive syndromes. Parkinsonism Relat Disord 1999; 5:59-65. [DOI: 10.1016/s1353-8020(99)00015-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/1998] [Revised: 02/22/1999] [Accepted: 02/22/1999] [Indexed: 10/17/2022]
|
81
|
Garcı́a-Ruiz PJ, Javier Jiménez-Jiménez F, Garcı́a de Yébenes J. Calcium channel blocker-induced parkinsonism: clinical features and comparisons with Parkinson's disease. Parkinsonism Relat Disord 1998; 4:211-4. [DOI: 10.1016/s1353-8020(98)00032-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/1998] [Revised: 09/30/1998] [Accepted: 09/30/1998] [Indexed: 11/28/2022]
|
82
|
Clinical features of essential tremor seen in neurology practice: a study of 357 patients. Parkinsonism Relat Disord 1997; 3:187-90. [DOI: 10.1016/s1353-8020(97)00031-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/1997] [Indexed: 11/22/2022]
|