Persistent hiccups associated with epidural ropivacaine in a newborn

Fasciculations in Children

Fasciculations are the most common form of spontaneous muscle contraction. They frequently occur in healthy individuals. However, there are a minority of situations that fasciculations are observed in association with specific neurologic disorders. Publications concerning the evaluation of pediatric patients experiencing fasciculations are limited. These children may undergo invasive or expensive diagnostic investigations that are unnecessary. Moreover, without careful consideration of differential diagnoses, rare neuromuscular disorders that present with fasciculations in the pediatric age group can be under-recognized by pediatric neurologists. This review examines the most important pediatric disorders presenting with fasciculations and other spontaneous muscle contractions to guide pediatric neurologists in evaluating these children.

Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

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

The role of DRP1 in ropivacaine-induced mitochondrial dysfunction and neurotoxicity

Ropivacaine is a commonly used local anaesthetic, but its side effects remain largely unknown. In the present study, we investigated the side effects of ropivacaine in human neuronal SH-5Y5Y cells. We show that 0.5% and 1% ropivacaine could cause fission-like mitochondrial morphological changes. Ropivacaine exclusively induces mitochondrial fission protein DRP1, generation of ROS and causes mitochondrial dysfunction including decreasing mitochondrial membrane potential, the activity of cytochrome C oxidase and ATP production. The side effects of ropivacaine appear to be dependent on DRP1 expression as silencing of DRP1 in neuronal cells abolishes ropivacaine-induced morphological changes and mitochondrial dysfunction. Silencing of DRP1 prevents ropivacaine-induced cellular LDH release and cell death. Moreover, DRP1-deficient neuronal cells are resistant to ropivacaine-induced apoptosis and silencing of DRP1 rescues the activity of cytochrome C oxidase and cellular ATP production. Collectively, our data indicate that imbalances in mitochondrial dynamics, mitochondrial dysfunction and cell death resulting from ropivacaine are all dependent on DRP1 expression. Our study provides valuable data to assess the safety of ropivacaine.

Baclofen for stroke patients with persistent hiccups: a randomized, double-blind, placebo-controlled trial

Background

The results of preclinical studies suggest that baclofen may be useful in the treatment of stroke patients with persistent hiccups. This study was aimed to assess the possible efficacy of baclofen for the treatment of persistent hiccups after stroke.

Methods

In total, 30 stroke patients with persistent hiccups were randomly assigned to receive baclofen (n = 15) or a placebo (n = 15) in a double-blind, parallel-group trial. Participants in the baclofen group received 10 mg baclofen 3 times daily for 5 days. Participants assigned to the placebo group received 10 mg placebo 3 times daily for 5 days. The primary outcome measure was cessation of hiccups. Secondary outcome measures included efficacy in the two groups and adverse events.

Results

All 30 patients completed the study. The number of patients in whom the hiccups completely stopped was higher in the baclofen group than in the placebo group (relative risk, 7.00; 95% confidence interval, 1.91–25.62; P = 0.003). Furthermore, efficacy was higher in the baclofen group than in the placebo group (P < 0.01). No serious adverse events were documented in either group. One case each of mild transient drowsiness and dizziness was present in the baclofen group.

Conclusions

Baclofen was more effective than a placebo for the treatment of persistent hiccups in stroke patients.

Trial registration

Chinese Clinical Trials Register: ChiCTR-TRC-13004554

Hiccup: mystery, nature and treatment

Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.