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Shivkumar V, Nemade D, Dhingra N. Persistent hiccups following thalamic hemorrhage: A case report. Heliyon 2023; 9:e16409. [PMID: 37274664 PMCID: PMC10238684 DOI: 10.1016/j.heliyon.2023.e16409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Persistent hiccups (lasting more than 48 hours) can cause physical and emotional distress. They can result in dehydration, exhaustion, malnutrition, insomnia, wound dehiscence, ventilatory desynchronization, and hemodynamic changes. Hiccups are thought to be due to a complex reflex arc involving peripheral nerves and central structures such as the brainstem, temporal lobe, basal ganglia, hypothalamus, and spinal cord levels C3-5. Medullary strokes, for instance, have been reported to cause hiccups. We report a patient with a thalamic bleed who developed persistent hiccups. A 56-year-old man was brought to the hospital in an unresponsive state. He was intubated for airway protection. CT brain showed a left thalamic hemorrhage with edema and mass effect on the 3rd ventricle, intraventricular extension of hemorrhage, and hydrocephalus. An external ventricular drain was placed successfully with adequate drainage. One week after admission, the patient developed persistent abdominal jerks. These jerks were occurring every 3-4 seconds and would last for hours with brief periods of remission. He was started on levetiracetam 1000 mg IV bid and then increased to 1500 mg IV BID without any improvement of symptoms. The patient was also placed on EEG which did not reveal any epileptiform abnormality but did show an EMG artifact. His electrolytes including sodium, and potassium, and corrected calcium levels were normal. He did not have any evidence of pneumonia or other infections. It was determined that these jerks were likely hiccups. Metoclopramide 10 mg IV was tried without any benefit. He was then started on Baclofen 10 mg PO TID which resulted in a significant improvement in hiccups. Our case suggests that thalamic lesions might also lead to persistent hiccups.
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Ehret CJ, Le-Rademacher J, Storandt MH, Martin N, Rajotia A, Jatoi A. A randomized, double-blinded feasibility trial of educational materials for hiccups in chemotherapy-treated patients with cancer. Support Care Cancer 2022; 31:30. [PMID: 36515742 PMCID: PMC9748902 DOI: 10.1007/s00520-022-07457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Chemotherapy can cause hiccups but few randomized controlled trials have focused on hiccups. This trial examined the feasibility of such research. METHODS This single-institution, multi-site trial used phone recruitment for patients: (1) 18 years or older, (2) able to speak/read English, (3) with a working e-mail address, (4) with hiccups 4 weeks prior to contact, and (5) with ongoing oxaliplatin or cisplatin chemotherapy. The primary outcome was feasibility. Patients were randomly assigned to one of two sets of educational materials, each of which discussed hiccups and palliative options. The experimental materials were almost identical to the standard materials but provided updated content based on the published medical literature. At 2 weeks, patients responded by phone to a 5-item verbally administered questionnaire. RESULTS This trial achieved its primary endpoint of recruiting 20 eligible patients within 5 months; 50 patients were recruited in 3 months. Among the 40 patients who completed the follow-up questionnaire, no statistically significant differences between arms were observed in hiccup incidence since initial contact, time spent reviewing the educational materials, and the troubling nature of hiccups. Twenty-five patients tried palliative interventions (13 in the experimental arm and 12 in the standard arm), most commonly drinking water or holding one's breath. Eleven and 10 patients, respectively, described hiccup relief after such an intervention. CONCLUSIONS Clinical trials for chemotherapy-induced hiccups are feasible and could address an unmet need.
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Affiliation(s)
- Christopher J Ehret
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Jennifer Le-Rademacher
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Nichole Martin
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Arush Rajotia
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
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Jatoi A. Evaluating and palliating hiccups. BMJ Support Palliat Care 2022; 12:475-478. [PMID: 35443973 DOI: 10.1136/bmjspcare-2022-003676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Wang D, Zi C, Zhang B, Wang B, Chen T, Wang L, Gao Y. Effectiveness and safety of metoclopramide in treatment of intractable hiccup: a protocol of systematic review and meta-analysis. BMJ Open 2022; 12:e059887. [PMID: 36202584 PMCID: PMC9540848 DOI: 10.1136/bmjopen-2021-059887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Hiccup is a common disease that not only occurred on adults but also on infants, which can severely do harm to patients' physical and psychological health. Metoclopramide has been reported to have effects on intractable hiccup. However, there is a limited evidence that describes the efficacy and safety of metoclopramide in the treatment of intractable hiccup. The aim of this article is to obtain evidence on the effectiveness and safety of metoclopramide in treating patients with intractable hiccup. METHODS AND ANALYSIS We will search the following databases, including PubMed, Cochrane Library, Embase, Web of Science, CBM, Wan-fang, VIP database, CNKI and MEDLINE from their inception to 11 November 2021. All the randomised controlled trials associated with metoclopramide in treating intractable hiccup will be included. Articles screened, selected and extracted will be performed by two researchers independently. The risk of bias will be assessed by using the Cochrane Collaboration. We will carry out the meta-analysis by using RevMan V.5.4 software. PROSPERO REGISTRATION NUMBER CRD42021293000.
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Affiliation(s)
- Die Wang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Changyan Zi
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Baocheng Zhang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Baojia Wang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Tao Chen
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Long Wang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Yongxiang Gao
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Wieland J, Martin N, Jatoi A. Healthcare Providers' Experiences with Hiccups in Patients with Cancer: Report of a United States National Survey. Am J Hosp Palliat Care 2022:10499091221130042. [PMID: 36172916 DOI: 10.1177/10499091221130042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hiccups occur in 15-40% of cancer patients, but previous research has not sought the perspectives of cancer healthcare providers. The objective of this research is to report on United States cancer healthcare providers' awareness of their patients' hiccups and these healthcare providers' perceived need for further palliation options. A survey was developed and then distributed throughout the United States via email to cancer healthcare providers; results are reported descriptively. Six hundred eighty-four cancer healthcare providers completed 2 eligibility screening questions which required them to have cared for an adequate number of patients (> 10 in the past 6 months) with "clinically significant" hiccups (defined as hiccups that persisted for >48 hours or occurred from cancer or from cancer care). Of 113 eligible healthcare providers, 90 completed the survey. Healthcare providers described hiccups as associated with stress/anxiety, fatigue, sleep problems, and decreased work/school productivity. In 49% of patients, healthcare providers initially prescribed medications (commonly chlorpromazine or baclofen); 18% expressed dissatisfaction with current palliation. Proffered comments included, "When current therapies do not work, it can be very demoralizing to our patients; " and "…my biggest complaint is that current treatments also come with their own side effects which can be quite severe." Discordance appears to exist between the percentage of cancer patients with hiccups and the percentage of cancer healthcare providers with awareness of their patients' hiccups. Nonetheless, healthcare providers described notable hiccup-associated symptoms in their patients and a need for more palliative options.
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Affiliation(s)
- Jana Wieland
- Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Nichole Martin
- Department of Oncology, 6915Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, 6915Mayo Clinic, Rochester, MN, USA
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Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. BMC Cancer 2022; 22:659. [PMID: 35705907 PMCID: PMC9202213 DOI: 10.1186/s12885-022-09760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background To our knowledge, previous studies have not investigated hiccups in patients with cancer with detailed patient-level data with the goal of capturing a broad spectrum of hiccup symptomatology. Methods This multi-site, single institution study examined consecutive medical records to better understand hiccups in patients with cancer. Results A total of 320 patients are the focus of this report. The median age of patients when hiccups were first reported in the medical record was 63 years (range: 21, 97 years) with 284 (89%) men and 36 (11%) women. The most common diagnose was gastrointestinal cancer. Hiccups most frequently occurred daily, as seen in 194 patients (62%), and the most common duration was less than 1 week, as seen in 146 patients (47%). However, nine patients had had daily hiccups for greater than 6 weeks, and 5 had symptoms for years. Cited etiology was non-chemotherapy medications in 36 (11%) and cancer chemotherapy in 19 (6%). Complications occurred in approximately a third and included insomnia in 51 patients (16%); hospitalization or emergency department visit in 34 (11%); and musculoskeletal pain in 23 (7%). Baclofen was the single most prescribed agent for hiccup palliation, but 100 patients received more than one medication. Medical procedures, which included acupuncture, paracentesis, or phrenic nerve block, were performed in 5 patients. In 234 patients (73%), the medical record documented hiccup cessation. Conclusions Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches.
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Ehret CJ, Jatoi A. Establishing the Groundwork for Clinical Trials With Hiccupops ® for Hiccup Palliation. Am J Hosp Palliat Care 2022; 39:1210-1214. [PMID: 34985350 DOI: 10.1177/10499091211063821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Because hiccup palliation remains an unmet clinical need, we report here on an early experience with Hiccupops, ® a patented product designed for the express purpose of providing a mechanism-based intervention for hiccup palliation. METHODS Meter Health, the developer and manufacturer of this patented product, used a purposive sampling approach to allow individuals with hiccups and a desire for hiccup palliation to purchase their agent and then to report on its efficacy or lack thereof. The authors of this report were provided these outcome data and allowed to analyze, report, and publish with no input from Meter Health with the exception of comments on accuracy. RESULTS This report focused on 43 surveys that were completed. In response to the question, "Did the Hiccupops work for the person they were purchased for?" 29 (67%) responded, "yes." Seven individuals (16%) responded, "no;" and 7 (16%) were "not sure." Write-in comments appeared to substantiate the effective palliative nature of the intervention: "A friend with 10 days of hiccups following… brain tumor surgery, after 2 days, they stopped!!!#." Another noted the following: "I like that if my hiccups get painful they're there as a quick relief." Less favorable comments were also noted: "She couldn't get past the…. taste." Another read as follows: "They were not effective in stopping my father's intractable hiccups…. I like that there is someone out there who cares about trying to stop people's hiccups." CONCLUSIONS This patented product appears to palliate hiccups in some individuals and merits further study.
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Affiliation(s)
| | - Aminah Jatoi
- Department of Oncology, 6915Mayo Clinic, Rochester, MN, USA
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Ergen M, Arikan F, Fırat Çetin R. Hiccups in Cancer Patients Receiving Chemotherapy: A Cross-Sectional Study. J Pain Symptom Manage 2021; 62:e85-e90. [PMID: 33587996 DOI: 10.1016/j.jpainsymman.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Hiccups are a symptom in cancer patients but it's less researched. OBJECTIVES The aimed to determine of prevalence of hiccups and treatment approach used in hiccup management in cancer patients receiving chemotherapy for nursing care. METHODS This study used a descriptive cross-sectional design with self-reported questionnaires and was conducted from November 2018-May 2019 in Turkey. For collection of the data, a Patient Information Form (sociodemographic and disease characteristics), and a Hiccups Evaluation Form were used for the patients. RESULTS Hiccups were observed in 37 (23%) of the 160 patients who met the criteria for inclusion in the study. The great majority of the patients suffering from hiccups were male (65.9%) and the type of cancer in the majority of these patients was gastrointestinal cancer (54.1%). It was determined that the duration of hiccups in 83.8% of patients observed with hiccups was between 0 and 48 hours, that the average severity of their hiccups was 3.81 ± 2.25 (0-10), and that hiccups in 59.5% of these patients was of low severity. It was found that only 10.8% of patients suffering from hiccups used pharmacological methods for relief and that 27% used nonpharmacological methods. CONCLUSION The results of the study showed that over one-fifth of cancer patients suffered from hiccups. This situation reveals that hiccups are an important symptom that needs to be carefully emphasised in oncology practice.
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Affiliation(s)
- Mevlüde Ergen
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey.
| | - Rüya Fırat Çetin
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
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Alvarez J, Anderson JM, Snyder PL, Mirahmadizadeh A, Godoy DA, Fox M, Seifi A. Evaluation of the Forced Inspiratory Suction and Swallow Tool to Stop Hiccups. JAMA Netw Open 2021; 4:e2113933. [PMID: 34143196 PMCID: PMC8214157 DOI: 10.1001/jamanetworkopen.2021.13933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study evaluates the usefulness of the forced inspiratory suction and swallow tool for stopping hiccups in a group of volunteers who completed an online questionnaire..
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Affiliation(s)
- James Alvarez
- Department of Medicine, University of Texas Health Science Center at San Antonio
| | | | - Patrick Larry Snyder
- Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center at San Antonio
| | - Alireza Mirahmadizadeh
- Department of Epidemiology and Public Health, Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mark Fox
- Department of Gastroenterology and Hepatology, University of Zürich, Zürich, Switzerland
- Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health Science Center at San Antonio
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Rajagopalan V, SenGupta D, Goyal K, Dube SK, Bindra A, Kedia S. Hiccups in neurocritical care. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Oh SY, Kang JH. Dexamethasone-Induced Hiccups: An Important But Inconspicuous Symptom in Cancer. J Palliat Med 2020; 23:1421. [PMID: 33174786 DOI: 10.1089/jpm.2020.0260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sung Yong Oh
- Department of Internal Medicine, Division of Hematology/Oncology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsand National University, Jinju, Republic of Korea
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Treatment of intractable hiccups using phrenic nerve block. J Clin Anesth 2019; 57:7-8. [PMID: 30836225 DOI: 10.1016/j.jclinane.2019.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
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Bahadoori A, Shafa A, Ayoub T. Comparison the Effects of Ephedrine and Lidocaine in Treatment of Intraoperative Hiccups in Gynecologic Surgery under Sedation. Adv Biomed Res 2019; 7:146. [PMID: 30596056 PMCID: PMC6282478 DOI: 10.4103/abr.abr_82_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation. Materials and Methods: This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery. Results: Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups. Conclusion: Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.
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Affiliation(s)
- Azadeh Bahadoori
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Shafa
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Taha Ayoub
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Obuchi T, Shimamura S, Miyahara N, Fujimura N, Iwasaki A. CO 2 retention: The key to stopping hiccups. CLINICAL RESPIRATORY JOURNAL 2018; 12:2340-2345. [PMID: 29729130 DOI: 10.1111/crj.12910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND While investigating the mechanisms behind hiccups, our team discovered what could be the sufficient physiological conditions for terminating even persistent cases. METHODS To investigate the role of CO2 retention, a healthy male volunteer was asked to perform three kinds of rebreathing experiments using different materials: (I) a 20 L air-filled plastic bag, (II) a 20 L air-filled plastic bag with a 1.5 × 1.5 cm hole and (III) a 20 L oxygen-filled plastic bag. During each experiment, CO2 level upon expiration (EtCO2 ) and inspiration (InspCO2 ) were measured until the volunteer gave up. Once the safety of this manoeuvre was demonstrated with the volunteer, we performed the technique using the materials from experiment (I) on two actual patients with persistent hiccups. RESULTS In experiments (I) and (III), InspCO2 increased from the beginning and reached almost the same level as EtCO2 after 90 seconds. Both levels continued simultaneously increasing, finally reaching 56 mm Hg in (I) and 79 mm Hg in (III), respectively. In (II), both increased; however, after 120 seconds, EtCO2 plateaued at 47 mm Hg and InspCO2 at 37 mm Hg. In the actual patients, both CO2 levels reached the same value of 35.9 mm Hg at 60 seconds and 37.0 mm Hg at 90 seconds, and hiccups stopped at 195 seconds and at 359 seconds when EtCO2 reached 50 mm Hg and 53 mm Hg, respectively. CONCLUSION The study determined that to successfully obstruct the mechanisms causing hiccups, it is necessary that the level of InspCO2 not only increases at the same level as EtCO2 , but also reaches approximately 50 mm Hg.
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Affiliation(s)
- Toshiro Obuchi
- Department of Thoracic Surgery, St. Mary's Hospital, Kurume, Japan
| | | | - Naofumi Miyahara
- Department of Thoracic Surgery, St. Mary's Hospital, Kurume, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Kurume, Japan
| | - Akinori Iwasaki
- Department of Thoracic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review. J Emerg Med 2018; 53:540-549. [PMID: 29079070 DOI: 10.1016/j.jemermed.2017.05.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 05/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another. OBJECTIVE This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects. METHODS A systematic literature search of PubMed, Embase, the Cochrane Library, and the New York Academy of Medicine was performed to find articles where a pharmacologic agent was used to treat intractable or persistent hiccups between the years 1966 and 2016. The GRADE method was used to assess the level of evidence for the studies included in this review. RESULTS This review identified 26 articles involving 10 pharmacologic treatment options that met our inclusion criteria. Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were found in the literature to be successful in treating hiccups. CONCLUSION Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials. No specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature. Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs.
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Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care 2017; 8:1-6. [DOI: 10.1136/bmjspcare-2016-001264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 11/03/2022]
Abstract
Persistent hiccups are a frustrating experience for palliative care patients, and can have a profound impact on their quality of life. This article provides an evidence-based approach overview of the causes and treatment of this not infrequently debilitating condition for such patients, with a management algorithm. In situations where no readily reversible cause is identified, or where simple physical manoeuvres, such as breath holding have failed, a systematic approach is required. Hiccups can be broadly divided into central and peripheral types. These respond differently to pharmacological intervention. The drug of choice for central causes of persistent hiccups is baclofen, with metoclopramide recommended as the first choice for peripheral causes. Midazolam may be useful in cases of terminal illness. Interventional procedures such as vagal or phrenic nerve block or stimulation should be considered in patients who are refractory to medications. The management of persistent hiccups still presents an ongoing clinical challenge however, requiring further research on pathophysiology and treatment strategies. Multinational randomised controlled trials to evaluate and compare both current and new medications or procedures to better manage this difficult condition are suggested as a means of reaching this goal.
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García Callejo FJ, Redondo Martínez J, Pérez Carbonell T, Monzó Gandía R, Martínez Beneyto MP, Rincón Piedrahita I. Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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García Callejo FJ, Redondo Martínez J, Pérez Carbonell T, Monzó Gandía R, Martínez Beneyto MP, Rincón Piedrahita I. Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:98-105. [PMID: 27542994 DOI: 10.1016/j.otorri.2016.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations. PATIENTS AND METHODS This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%). RESULTS A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders -mainly gastroesophageal reflux- were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died. CONCLUSIONS Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.
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Affiliation(s)
| | - Jaume Redondo Martínez
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Tomás Pérez Carbonell
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Rafael Monzó Gandía
- Servicio de Otorrinolaringología, Hospital General de Requena, Requena, Valencia, España
| | - M Paz Martínez Beneyto
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Inés Rincón Piedrahita
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
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Hernandez SL, Fasnacht KS, Sheyner I, King JM, Stewart JT. Treatment of Refractory Hiccups with Amantadine. J Pain Palliat Care Pharmacother 2015; 29:374-7. [DOI: 10.3109/15360288.2015.1101640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther 2015; 42:1037-50. [PMID: 26307025 DOI: 10.1111/apt.13374] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 07/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat. AIM To review the management of hiccups, including a systematic review of reported efficacy and safety of pharmacological treatments. METHODS Available articles were identified using three electronic databases in addition to hand searching of published articles. Inclusion criteria were any reports of pharmaceutical therapy of 'hiccup(s)', 'hiccough(s)' or 'singultus' in English or German. RESULTS Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agents may provide benefit; however, systematic review revealed no adequately powered, well-designed trials of treatment. The use of baclofen and metoclopramide are supported by small randomised, placebo-controlled trials. Observational data suggest that gabapentin and chlorpromazine are also effective. Baclofen and gabapentin are less likely than standard neuroleptic agents to cause side effects during long-term therapy. CONCLUSIONS This systematic review revealed no high quality data on which to base treatment recommendations. Based on limited efficacy and safety data, baclofen and gabapentin may be considered as first line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve.
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Affiliation(s)
- M Steger
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Schneemann
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Zürich Center for Integrated Human Physiology, Zürich, Switzerland
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