1/3. Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis.A patient underwent an emergency Caesarean section under general anaesthesia for an antepartum haemorrhage. Following delivery of a live infant, cyclizine was administered in accordance with departmental anti-emetic protocol. On awakening she was confused, slow to articulate and had slurred speech. A computed tomography (CT) scan, which was performed to exclude an intracranial event, was normal. Her symptoms were suggestive of a lingual-facial-buccal dyskinesia as seen with dopamine antagonists. A presumptive diagnosis of a dystonic reaction to cyclizine was made. She received two doses of procyclidine before her symptoms completely resolved. cyclizine has had a resurgence in popularity owing to the recent withdrawal of droperidol and anaesthetists should be aware that, although extremely rare, dystonic reactions may occur with this agent.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Effect of deep brain stimulation of GPI on neuronal activity of the thalamic nucleus ventralis oralis in a dystonic patient.OBJECTIVE: To record the possible effect of acute deep brain stimulation (DBS) of the globus pallidus internus (GPI) on the neuronal activity of the ventralis oralis anterior (VOA) nucleus of the thalamus. methods: Under general propofol anaesthesia, extracelullar single unit recordings were performed in VOA of a post-anoxic dystonic patient previously implanted with GPI located electrodes for chronic DBS. RESULTS: neurons recorded in the VOA could be classified in two cell subpopulations: a high firing rate (16.5 Hz) and low burst index (BI; 15.6) type and a low firing rate (5.5 Hz) and high BI (35.6) type. GPI electrical stimulation reduced the frequency and increased the BI of the high firing rate cells while leaving the other cell type unchanged. CONCLUSION: These results demonstrate that pallidal DBS is able to inhibit a subpopulation of motor thalamic cells and question the pathophysiological model of dystonia based on a low firing rate of GPI cells.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. Refractory dystonia during propofol anaesthesia in a patient with torticollis-dystonia disorder.PURPOSE: To report a case of refractory dystonia under propofol anaesthesia in a patient with torticollis-dystonia disorder. CLINICAL FEATURES: A 38-yr-old man presented for an MRI scan for investigation of a torticollis-dystonia disorder. There was a biphasic response to propofol with complete amelioration of the torticollis and limb dystonia initially with subsequent recurrence under deep propofol anaesthesia. Coadministration of midazolam, diazepam, and thiopentone were not successful in abolishing the recurrent dystonia. CONCLUSIONS: propofol should preferably be avoided in patients with torticollis and dystonias. Where complete control of movements is required, it may be necessary to consider general endotracheal anaesthesia with muscle relaxants.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |