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Sakurai M, Matsui Y, Takazawa T, Kabasawa Y, Nagumo W, Takada R, Saito S. Treatment-resistant hiccups during general anesthesia possibly caused by remimazolam: a case report. JA Clin Rep 2024; 10:32. [PMID: 38787462 PMCID: PMC11126544 DOI: 10.1186/s40981-024-00714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Previous reports have described hiccups during general anesthesia that were possibly induced by drugs, including benzodiazepines. However, there are few reports of hiccups caused by remimazolam. Case presentation A 75-year-old woman underwent corneal transplantation under general anesthesia with remimazolam. She presented with hiccups once the effects of muscle relaxants used during induction wore off, which persisted even after various treatments, such as the administration of antipsychotic drugs. However, when remimazolam administration was terminated after surgery to awaken the patient, the hiccups stopped and did not recur after extubation. Evaluation of predicted blood levels of remimazolam suggests that higher levels of remimazolam might cause hiccups. CONCLUSION Remimazolam might induce hiccups during general anesthesia. Anesthesiologists should consider administering muscle relaxants or changing the anesthetic in cases of refractory hiccups under general anesthesia.
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Affiliation(s)
- Miku Sakurai
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
| | - Yusuke Matsui
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
| | - Tomonori Takazawa
- Department of Anesthesiology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Yoji Kabasawa
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
| | - Wataru Nagumo
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
| | - Ryo Takada
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
| | - Shigeru Saito
- Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan
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Tang S, Lu J, Xu C, Wei L, Mei S, Chen R, Meng QT. Feasibility and Safety of Remazolam versus Propofol When Inserting Laryngeal Masks Without Muscle Relaxants During Hysteroscopy. Drug Des Devel Ther 2023; 17:1313-1322. [PMID: 37152102 PMCID: PMC10162397 DOI: 10.2147/dddt.s408584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of remazolam compared with propofol in patients who underwent laryngeal mask airway (LMA) insertion without the use of muscle relaxant agents during hysteroscopic surgery. Patients and Methods A total of 72 patients undergoing hysteroscopy with LMA insertion were assigned to two groups. The patients in the remazolam group received 0.3 μg/kg sufentanil, 0.3 mg/kg remazolam and 1.2 mg/kg remifentanil, whereas the patients in the propofol group received 0.3 μg/kg sufentanil, 2.0 mg/kg propofol and 1.2 mg/kg remifentanil for insertion of the LMA. The primary endpoint was the summed score of the insertion conditions. The secondary endpoints included hemodynamics, the duration of induction, the duration of insertion, tidal volume, plateau pressure and adverse events. Results No difference was identified between the propofol group and remazolam group in the median summed score [18.0 (18.0, 18.0), 18.0 (17.0, 18.0), respectively, P > 0.05]. The induction duration was significantly longer (P < 0.05) in the remazolam group than propofol group. The cost of dopamine (P < 0.05) was significantly lower in the remazolam group compared with the patients in the propofol group, while the plateau pressure (P < 0.05) and the incidence of transient mild laryngospasm (P < 0.05) were significantly higher in the remazolam group. No differences were identified between the two groups in terms of heart rate, tidal volume, injection pain or hiccups (P > 0.05). Conclusion Remazolam provided similar insertion conditions and better hemodynamic stability than propofol during LMA insertion without the use of muscle relaxant agents. However, a higher incidence of transient mild laryngospasm was found in the remazolam group, which should be considered.
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Affiliation(s)
- Shan Tang
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jingxiao Lu
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Cheng Xu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Lu Wei
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Shenglan Mei
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Rong Chen
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Qing-Tao Meng
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
- Correspondence: Qing-Tao Meng, Tel +8615178857650, Email
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Giannos P, Katsikas Triantafyllidis K, Geropoulos G, Kechagias KS. Persistent Hiccups as an Atypical Presentation of SARS-CoV-2 Infection: A Systematic Review of Case Reports. Front Neurol 2022; 13:819624. [PMID: 35444608 PMCID: PMC9014175 DOI: 10.3389/fneur.2022.819624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 01/08/2023] Open
Abstract
Symptoms, such as fever, dry cough, dyspnoea, and respiratory distress, are commonly described in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Recently, a growing number of cases pertained to persistent hiccups have been reported by SARS-CoV-2 infected patients. The aim of this systematic review was to screen the current literature and provide a summary of the reported cases of SARS-CoV-2 infected patients presenting with persistent hiccups. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and Web of Science databases were searched from inception until October 2021. Case reports or case series that provided a separate clinical description for patients with presenting complaints of persistent hiccups before or after COVID-19 diagnosis were retrieved. The critical appraisal checklist for case reports provided by the Joanna Briggs Institute (JBI) was employed to evaluate the overall quality of the eligible studies. We identified 13 eligible studies that included 16 hospitalized COVID-19 patients who complained of persistent hiccups. The mean duration of hiccups was 4.6 days reported in 88% (14/16) patients. Hypertension was the most common comorbidity present in 50% (8/16) of patients followed by diabetes mellitus (4/16). Moreover, 44% (7/16) of patients received only one medication for managing the hiccups with metoclopramide (5/16) followed by chlorpromazine and baclofen (4/16) used as primary treatment. Equally, 44% of patients (7/16) received dexamethasone followed by azithromycin (5/16), ivermectin (4/16), and ceftriaxone (4/16) for managing the infection from SARS-CoV-2. The majority of patients (14/16) improved after initiation of treatment. Persistent hiccups are possibly a rare symptom that clinicians may expect to encounter in patients infected with SARS-CoV-2. Although there is not ample proof to propose causation, increased awareness about the diversity of presentations of SARS-CoV-2 infection could be crucial in the early recognition of the disease.
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Affiliation(s)
- Panagiotis Giannos
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, United Kingdom.,Society of Meta-Research and Biomedical Innovation, London, United Kingdom
| | - Konstantinos Katsikas Triantafyllidis
- Society of Meta-Research and Biomedical Innovation, London, United Kingdom.,Department of Nutrition and Dietetics, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Konstantinos S Kechagias
- Society of Meta-Research and Biomedical Innovation, London, United Kingdom.,Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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Zhang Y, Dai G, Xu H, Liu Y, Liao M, Zhang X. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia: a reply. Minerva Anestesiol 2022; 88:194-195. [PMID: 35315628 DOI: 10.23736/s0375-9393.21.16169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ying Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Guangrong Dai
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Hai Xu
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yingge Liu
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Minhui Liao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China -
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Incecik F, Herguner O. Carbamazepine-induced hiccups: A case report. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Karampoor S, Afrashteh F, Laali A. Persistent hiccups after treatment of COVID-19 with dexamethasone: A case report. Respir Med Case Rep 2021; 34:101515. [PMID: 34522605 PMCID: PMC8431841 DOI: 10.1016/j.rmcr.2021.101515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022] Open
Abstract
Hiccups are involuntary and spasmodic contractions of the diaphragm, and multiple etiological factors have been suggested to be involved. Medications, such as dexamethasone, as well as some diseases, such as pneumonia, can cause persistent (>48 h) hiccups. Here, we report a 58-years-old male who had a fever, myalgia, cough, and ground-glass view in the chest computed tomography, and his PCR test for Covid-19 was positive. During the treatment course, persistent hiccups were developed after taking dexamethasone and lasted for six days. All cardiac and neurologic examinations were performed, and all of them were normal. After evaluating all of the possible underlying causes, dexamethasone was replaced by prednisolone. Upon a change in his treatment regimen, hiccups began to stop, and his symptoms also disappeared. Hiccups may occur in patients who have pneumonia and other infectious diseases. Dexamethasone can also stimulate hiccups along with infections.
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Affiliation(s)
- Sajad Karampoor
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Afrashteh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Laali
- Department of Infectious Diseases, Firoozgar Medical and Educational Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author.
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Nishijima K, Kizawa Y, Yamauchi T, Odagiri T, Ito T, Kaneishi K, Shimizu K, Morita T, Mori M. Prevalence and associated factors of orphan symptoms in advanced cancer patients: a multicenter observational study. Support Care Cancer 2021; 29:5537-5547. [PMID: 33725175 DOI: 10.1007/s00520-021-06144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aims of this study were to examine the prevalence of myoclonus, sweating, pruritus, hiccup, and vesical and rectal tenesmus, and to explore associated factors in patients with advanced cancer. METHODS This multicenter prospective cohort study was conducted in 23 inpatient hospices/palliative care units in Japan from January to December 2017. The prevalence and characteristics of each symptom were assessed on admission and in the 3 days before death. We selected factors that might influence the occurrence of each symptom and investigated the association. RESULTS A total of 1896 patients were enrolled. The prevalence of orphan symptoms rose from admission to the 3 days before death: myoclonus 1.3 to 5.3% (95% CI 0.9-1.9%/4.3-6.5%), sweating 1.8 to 4.1% (95% CI 1.3-2.6%/3.1-5.1%), hiccup 1.1 to 1.8% (95% CI 0.7-1.7%/1.2-2.6%), and tenesmus 0.7 to 0.9% (0.4-1.2%/0.5-1.5%). Prevalence of pruritus fell from 3.5 to 2.5% (95% CI 2.7-4.4%/1.8-3.4%). Sweating, pruritus, and hiccups persisted throughout the day in nearly half of the patients. Myoclonus was significantly associated with brain tumors, sweating with opioids and antipsychotics, pruritus with liver and biliary tract cancer, cholestasis and severe diabetes, hiccup with male gender, digestive tract obstruction, severe diabetes, and renal failure. Vesical tenesmus was associated with urinary cancer, antipsychotics, and anticholinergics and rectal tenesmus with pelvic cavity cancer. CONCLUSION We found that orphan symptoms occurred in 0.5-5.0% of patients, increased over time except for pruritus, and persisted in half of the patients.
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Affiliation(s)
- Kaoru Nishijima
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | | | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keisuke Kaneishi
- Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Keiji Shimizu
- Department of Palliative Care Internal Medicine, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Methylphenidate-Induced Persistent Hiccups in a Child With ADHD Relieved by Add-On Risperidone. Am J Ther 2020; 28:e706-e707. [PMID: 33021543 DOI: 10.1097/mjt.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Abubaker AK, Rabadi DK, Kassab M, Al-Qudah MA. Persistent Hiccups After Cervical Epidural Steroid Injection. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:397-399. [PMID: 29615600 PMCID: PMC5900462 DOI: 10.12659/ajcr.908536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 60 Final Diagnosis: Persistent hiccups Symptoms: Hiccups Medication: — Clinical Procedure: Cervical epidural steroid injection Specialty: Anesthesiology
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Affiliation(s)
- Ahmad Khaled Abubaker
- Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Daher K Rabadi
- Department of Anesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Manal Kassab
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Mohannad A Al-Qudah
- Department of Special Surgery, Faculty of Medicine Jordan University of Science and Technology (JUST), Irbid, Jordan
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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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Transient hiccups associated with oral dexamethasone. Case Rep Dent 2013; 2013:426178. [PMID: 24224105 PMCID: PMC3810065 DOI: 10.1155/2013/426178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/05/2013] [Indexed: 11/17/2022] Open
Abstract
Hiccups, or singulata (hiccup is singultus), are commonly experienced by most people at one time or another and are usually brief and self-limiting. Although pharmacotherapeutic agents are not generally considered causal in the etiology of hiccups, many clinicians empirically associate episodic hiccups in their patients as being drug induced. The two classes of drugs most often cited as causing hiccups are corticosteroids and benzodiazepines. This report involved a patient who was given preoperative dexamethasone and developed hiccups before anesthesia and surgery commenced. He at no time was in distress, and the surgical procedure was completed without complication. By the second postsurgical day his hiccups were resolved completely. Although the association may be anecdotal, many clinicians consider hiccups a potential side effect of steroid therapy, especially high doses of steroids. Of interest in this case is the relatively low dose of corticosteroid used, albeit apparently linked to his hiccups. Practitioners should be aware of this potential condition.
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Abstract
Hiccups are a product of involuntary, intermittent spasmodic contraction of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration and abrupt closure of the glottis. The exact pathophysiology of hiccups remains unknown. However, certain neurotransmitters, medications, and other factors have been implicated.
We report a case of a 38 year old patient who developed hiccups three days after adding aripiprazole 5 mg once a day to his medication regimen. Medical and environmental causes were ruled out and aripiprazole was discontinued. One day later, the hiccups resolved.
Several case reports have described patients who developed hiccups when treated with aripiprazole and related this to changes in neurotransmitter concentrations. However, due to limited literature, it was difficult to determine rate of occurrence of this adverse event with aripiprazole.
A temporal but not a causal relationship was observed between initiating aripiprazole and development of hiccups in this patient. A causal relationship cannot be established since the patient was not re-challenged with aripiprazole. Nonetheless, clinicians should be cognizant that use of aripiprazole may be associated with hiccups.
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Affiliation(s)
- Rania Kattura
- 1 Clinical Assistant Professor, University of Texas at Austin College of Pharmacy, Austin, TX
| | - Prakeh Shet
- 2 Psychiatrist, Mexia State Supported Living Center
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Abstract
OBJECTIVE: To determine whether gabapentin is effective in the treatment of persistent or intractable hiccups. DATA SOURCES: A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION: All data sources were considered for inclusion. Preference was given for articles written in English, although one abstract in German was used. DATA SYNTHESIS: Because of the low incidence of persistent or intractable hiccups, few if any controlled clinical trials are conducted on the efficacy of drug treatment. Therefore, most of the data involve case reports or case series. We evaluated 17 case reports and 2 case series involving gabapentin therapy for persistent or intractable hiccups. Therapeutic outcomes with gabapentin were positive in all cases, with temporal evidence suggesting an effect, but outcomes often were obscured by combination therapy and comorbidities in some cases. Case reports suggest that gabapentin might be useful as a second-line agent in patients undergoing stroke rehabilitation or in the palliative care setting where chlorpromazine adverse effects are undesirable. Gabapentin was very well tolerated, with only a few minor adverse effects. CONCLUSIONS: Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients.
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Affiliation(s)
- Dennis F Thompson
- Dennis F Thompson PharmD FASHP FCCP, Dean and Nelson M. Sims Endowed Chair, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK
| | - Krista G Brooks
- Krista G Brooks PharmD, Assistant Professor of Pharmacy Practice, Southwestern Oklahoma State University
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Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013; 2013:CD008768. [PMID: 23440833 PMCID: PMC6452787 DOI: 10.1002/14651858.cd008768.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Persistent and intractable hiccups (typically defined as lasting for more than 48 hours and one month respectively) can be of serious detriment to a patient's quality of life, although they are relatively uncommon. A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. OBJECTIVES The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. SEARCH METHODS Studies were identified from the following databases: CENTRAL, CDSR, DARE, MEDLINE, EMBASE, CINAHL, PsychINFO and SIGLE (last search March 2012). The search strategy for all the databases searched was based on the MEDLINE search strategy presented in Appendix 1. No additional handsearching of journals was undertaken. Investigators who are known to be carrying out research in this area were contacted for unpublished data or knowledge of the grey literature. SELECTION CRITERIA Studies eligible for inclusion in this review were randomised controlled trials (RCTs) or controlled clinical trials (CCTs). INCLUSION CRITERIA adults (over 18 years old) diagnosed with persistent or intractable hiccups (hiccups lasting more than 48 hours), treated with any pharmacological or non-pharmacological intervention. EXCLUSION CRITERIA less than ten participants; no assessment of change in hiccup frequency or intensity in outcome measures. DATA COLLECTION AND ANALYSIS Two independent review authors assessed each abstract and title for relevance. Disagreement on eligibility was resolved by discussion. Where no abstract was available the full paper was obtained and assessed. We obtained full copies of the studies which met the inclusion criteria for further assessment. Two review authors independently collected data from each appropriate study and entered them into the software Review Manager 5. Two independent review authors assessed the risk of bias using the RevMan 5 'Risk of bias' table following guidance from the Cochrane Handbook of Systematic Reviews of Interventions (Higgins 2009). MAIN RESULTS A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. All four studies had a high risk of bias, did not compare the intervention with placebo, and failed to report side effects or adverse events for either the treatment or control groups. Due to methodological differences we were unable to perform a meta-analysis of the results. No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria. AUTHORS' CONCLUSIONS There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions.The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. As the symptom is relatively rare, trials would need to be multi-centred and possibly multi-national.
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Menon M. Gabapentin in the treatment of persistent hiccups in advanced malignancy. Indian J Palliat Care 2012; 18:138-40. [PMID: 23093831 PMCID: PMC3477368 DOI: 10.4103/0973-1075.100839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hiccups are a distressing symptom in advanced malignancies in the setting of palliative care. A case of persistent hiccups treated with oral Gabapentin is presented to highlight the clinical and ethical dilemmas in patients with advanced malignancy. A 70-year-old male with non-small cell cancer of the lung with widespread metastases presented with persistent hiccups. The patient and family sought only symptom relief from home, without hospitalization or further investigations. The hiccups were dramatically relieved by oral Gabapentin, highlighting the recent reports that mention this molecule as being useful for hiccups. Gabapentin is a simple tool that may be utilized by palliative care physicians to relieve hiccups in advanced malignancies.
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Affiliation(s)
- Mahesh Menon
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital, Four bungalows, Andheri (West), Mumbai-53, India
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Liu CC, Lu CY, Changchien CF, Liu PH, Perng DS. Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy. World J Gastroenterol 2012; 18:3595-601. [PMID: 22826626 PMCID: PMC3400863 DOI: 10.3748/wjg.v18.i27.3595] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/12/2011] [Accepted: 05/06/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity, duration and typical onset time.
METHODS: Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups: EGD without sedation (Group A) and BDE with sedation (Group B). The use of sedation was based on the patients’ request. Anesthesiologists participated in this study by administrating sedative drugs as usual. A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients. The incidence, duration and onset time of hiccups were measured in both groups. In addition, the association between clinical variables and hiccups were analyzed.
RESULTS: A total of 435 patients were enrolled in the study. The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%, respectively). The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio: 8.79, P < 0.001) after adjustment. The incidence of hiccups in males under sedation was high (67.4%). The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028). The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).
CONCLUSION: Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation. Midazolam was significantly associated with an increased risk of hiccups. Furthermore, patients with GERD are prone to develop hiccups.
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Arroyo-Cózar M, Grau Delgado J, Gabaldón Conejos T. Hiccups induced by midazolam during sedation in flexible bronchoscopy. Arch Bronconeumol 2012; 48:103. [PMID: 22265321 DOI: 10.1016/j.arbres.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 11/07/2011] [Accepted: 11/17/2011] [Indexed: 11/25/2022]
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Persistent Hiccups Due to Fixed-Dose Tenofovir and Emtricitabine. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181f5eab1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bagdure DN, Reiter PD, Bhoite GR, Dobyns EL, Laoprasert P. Persistent hiccups associated with epidural ropivacaine in a newborn. Ann Pharmacother 2011; 45:e35. [PMID: 21652787 DOI: 10.1345/aph.1p760] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of persistent hiccups associated with epidural ropivacaine in a newborn infant. CASE SUMMARY A term female infant (3.05 kg) received epidural ropivacaine for pain control during and after an operative procedure to correct a tracheoesophageal fistula. Three intermittent doses of ropivacaine were administered during the operative period (total dose 2.29 mg/kg) followed by a continuous epidural (caudal) infusion (0.1% ropivacaine; initial dose 0.23 mg/kg/h plus fentanyl 0.46 μg/kg/h). The infant was extubated in the recovery area and transferred to the intensive care unit. Within hours of transfer, she developed persistent hiccups. The epidural infusion was titrated for pain control, up to 0.32 mg/kg/h (ropivacaine). The hiccup frequency increased to every 10-30 seconds, with the patient appearing hypotonic with lip trembling and intermittent tongue fasciculation. An electroencephalogram did not show any epileptiform activity or focal features consistent with seizure activity. The epidural infusion was reduced to 0.26 mg/kg/h (ropivacaine), with dramatic improvement in hiccups and tone. The infusion was discontinued and complete resolution of hiccups was observed. DISCUSSION Ropivacaine is commonly used for infiltration anesthesia and peripheral and epidural block anesthesia. Use of the Naranjo probability scale determined that our patient's hiccups were probably caused by ropivacaine. To our knowledge, this is the first report of persistent hiccups associated with epidural ropivacaine. CONCLUSIONS Clinicians should consider the potential of neurotoxicity, manifested as persistent hiccups, when epidural ropivacaine is administered to young infants.
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Affiliation(s)
- Dayanand N Bagdure
- Pediatric Intensive Care Unit, Section of Critical Care Medicine, The Children's Hospital, Aurora, CO, USA.
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Javot L, Scala-Bertola J, Petitpain N, Trechot P, Pere P, Gillet P. Methotrexate-induced hiccups. Rheumatology (Oxford) 2011; 50:989-90. [DOI: 10.1093/rheumatology/keq438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gilbar P, McPherson I. Severe hiccups during chemotherapy: corticosteroids the likely culprit. J Oncol Pharm Pract 2009; 15:233-6. [PMID: 19276142 DOI: 10.1177/1078155209102336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hiccups generally are self-limiting and of short duration. Those lasting more than 48 h or recurring at frequent intervals are termed persistent. There are numerous causes of hiccups, with medications implicated only rarely. While hiccups are usually benign, severe attacks may lead to exhaustion, eating difficulties, and affect quality of life. We report a case of severe hiccups in a patient receiving chemotherapy (oxaliplatin, 5-fluorouracil, leucovorin) for metastatic colorectal cancer. Hiccups began on the day following chemotherapy and continued constantly for over 30 h until relief was obtained by sucking the juice of a fresh lemonade. A similar pattern occurred in the next two chemotherapy cycles. Dexamethasone had been prescribed as prophylaxis against emesis and this was considered a possible cause. Withholding dexamethasone in the next cycle led to elimination of hiccups without having an impact on control of nausea and vomiting. A number of case reports have linked corticosteroids, particularly dexamethasone, to the occurrence of hiccups. Antineoplastic agents have occasionally been reported as causing hiccups; however, in most of these cases, corticosteroids, as part of the treatment protocol or as antiemetics, may have been a more likely cause. This case serves an as important reminder that adverse effects appearing during chemotherapy may not necessarily be due to antineoplastic agents. In the case of hiccups, oncology health professionals should review all medications and non drug-related factors before assigning causality. J Oncol Pharm Practice (2009) 15: 233—236.
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Affiliation(s)
- Peter Gilbar
- Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba 4350, Australia,
| | - Ian McPherson
- Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba 4350, Australia
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Tegeler ML, Baumrucker SJ. Gabapentin for Intractable Hiccups in Palliative Care. Am J Hosp Palliat Care 2008; 25:52-4. [DOI: 10.1177/1049909107305657] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. This is partly because hiccups are relatively uncommon and many of the proposed treatments are unproven or have long-term side effects. Pharmacologic treatments rather than home remedies or surgical treatments are more appropriate for the palliative care patient. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective.
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Affiliation(s)
- Monica L. Tegeler
- East Tennessee State University College of Medicine, Kingsport, Tennessee
| | - Steven J. Baumrucker
- East Tennessee State University College of Medicine, Kingsport, Tennessee, , Palliative Medicine Service, Wellmont Health System, Kingsport, Tennessee
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Amirjamshidi A, Abbassioun K, Parsa K. Hiccup and neurosurgeons: a report of 4 rare dorsal medullary compressive pathologies and review of the literature. ACTA ACUST UNITED AC 2007; 67:395-402; discussion 402. [PMID: 17350413 DOI: 10.1016/j.surneu.2006.10.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to present 4 rare cases of medullary compressive lesions presenting with IH, to discuss the indications for neurosurgical decompression in such cases, and to review the possible etiologies of IH briefly. METHODS The reported cases include (1) a 19-year-old adolescent boy and a 21-year-old man with Chiari I malformation and cervical syrinx compressing or tightening the cervico-medullary junction; (2) a 35-year-old man with ependymoma extending from the lower half of the fourth ventricle to C1/C2 junction and compressing this part of the medulla; and (3) a 16-year-old adolescent boy who was referred to the emergency department in severe distress because of IH, occurring as a result of a distal PICA aneurysm located on the floor of the lower triangle of the fourth ventricle. RESULTS Surgical decompression in all the cases was successful in withholding the hiccups. CONCLUSION The dorsal medullary area is not an unusual location for genesis of hiccup. When encountering a case of IH, appropriate CNS imaging studies should be included in the evaluation protocol.
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Affiliation(s)
- Abbass Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 19585, Iran.
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Abstract
Hiccup is a sudden contraction of the inspiratory muscles, followed by an abrupt closure of the glottis, thus producing a characteristic sound. In the literature, some drugs have been reported to induce hiccup. We discuss three case reports after administration of benzodiazepine to healthy young subjects during two clinical trials. In the first study (a bioequivalence trial of two forms of lormetazepam, tablets and oral solution), 12 subjects were included in an open controlled crossover study with two periods separated by a washout of 7 days. Two subjects presented with hiccup after administration of lormetazepam (2mg oral solution). The symptom resolved in 10 and 40 minutes, respectively. In one subject, rechallenge with a tablet of lormetazepam was positive. The aim of the second study was to assess the effect of sleep deprivation and lorazepam-induced sedation on saccadic eye movements in 12 healthy subjects. Hiccup occurred in one subject 3h 15 after administration of a single oral dose of lorazepam (2mg) and resolved in 45 minutes. All cases were evaluated according to the French imputation method. These observations are discussed with regard to the drug classes mentioned most frequently in the literature.
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Affiliation(s)
- Joëlle Micallef
- Centre de Pharmacologie Clinique et d'Evaluations Thérapeutiques et Service de Pharmacologie Clinique, Hôpital de la Timone, Marseille, France.
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Barriocanal Barriocanal AM, Vaqué Cabañas A, Pérez-Andrés R, Olivé Marques A. Crisis de hipo tras infiltración intraarticular con parametasona. Med Clin (Barc) 2005; 125:158. [PMID: 15989860 DOI: 10.1157/13076947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cherny NI. Taking care of the terminally ill cancer patient: management of gastrointestinal symptoms in patients with advanced cancer. Ann Oncol 2005; 15 Suppl 4:iv205-13. [PMID: 15477309 DOI: 10.1093/annonc/mdh928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- N I Cherny
- Pain Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
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Ifran A, Kaptan K, Beyan C. Intractable hiccups may develop with cyclophosphamide infusion. Am J Hematol 2004; 77:319-20. [PMID: 15495237 DOI: 10.1002/ajh.20173] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hung YM, Miller MA, Patel MM. Persistent Hiccups Associated With Intravenous Corticosteroid Therapy. J Clin Rheumatol 2003; 9:306-9. [PMID: 17041480 DOI: 10.1097/01.rhu.0000089792.61349.0c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Singulata, commonly known as hiccups, have many causes and are most often idiopathic and short-lived. Occasionally, hiccups can be persistent and becoming quite bothersome, distracting, and even disabling. Many medications have been implicated as a cause of hiccups. Although uncommon, corticosteroids and benzodiazepines are 2 classes of drugs most frequently associated with the development of hiccups. The following case series describes 5 patients with intravenous corticosteroid-associated hiccups reported to our adverse drug reaction reporting system between January 1998 and December 2000. Physicians using intravenous corticosteroids should be aware of this potential complication.
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Affiliation(s)
- Yao-Min Hung
- Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Abstract
There are close to a hundred causes for hiccups, or singultus, the most common of which are gastrointestinal. Causes may be natural or drug induced, and the same agents that are used to treat hiccups may also induce them. Hiccups can be classified by their duration, as follows: up to 48 hours, acute; longer than 48 hours, persistent; and more than two months, intractable. Treatment options for hiccups can include both pharmacologic and nonpharmacologic agents. If the cause of hiccups can be identified, it is, of course, preferable to direct the treatment at that cause. However many times a cause cannot be identified; in this case, general measures or treatments should be instituted. Intractable hiccups can occur in the palliative care population. When they do, it can be extremely distressing and have a significant impact on quality of life. Pharmacologic approaches are often the most rational therapies for these patients. Baclofen seems to be a promising drug for use with both palliative care and perioperative patients, and using garabentin as an add-on to baclofen may also be a reasonable option to consider
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Affiliation(s)
- Howard S Smith
- Presbyterian University Hospital, University of Pittsburgh Medical Center, Pennsylvania, USA
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Kanaya N, Nakayama M, Kanaya J, Namiki A. Atropine for the treatment of hiccup after laryngeal mask insertion. Anesth Analg 2001; 93:791-2. [PMID: 11524358 DOI: 10.1097/00000539-200109000-00047] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPLICATIONS We describe three patients in whom hiccups were treated successfully by atropine. Although further clinical investigation is needed, atropine may be useful in the treatment of hiccups after the laryngeal mask airway insertion.
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Affiliation(s)
- N Kanaya
- Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
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