[Hypoglossal nerve injury following endotracheal intubation]. / Uitval van de N. hypoglossus na orotracheale intubatie.

BACKGROUND: Endotracheal intubation is required to keep the airway open when a patient undergoes surgery under general anaesthetic. Here we present a rare complication of endotracheal intubation. CASE: A 70-year-old woman underwent repeat pulmonary vein isolation for atrial fibrillation under general anaesthetic. Because the procedure was expected to take a long time, and because the surgeon might want to perform transoesophageal echocardiography, we chose to carry out endotracheal intubation on this patient. After the operation she showed dyspnoea, problems with swallowing and dysarthria. Physical examination showed elevation of the right pharyngeal arch and deviation of the tongue to the right. This was found to be due to hypoglossal nerve injury. CONCLUSION: Hypoglossal nerve injury is a rare complication of endotracheal intubation. There is no proven effective treatment for this complication. Prognosis is favourable: 69% of the patients recover completely in the first 6 months following intubation. Patients with this complication should receive supportive therapy, such as speech therapy and dietary modifications, to prevent aspiration.

Almost all antipsychotics result in weight gain: a meta-analysis.

INTRODUCTION: Antipsychotics (AP) induce weight gain. However, reviews and meta-analyses generally are restricted to second generation antipsychotics (SGA) and do not stratify for duration of AP use. It is hypothesised that patients gain more weight if duration of AP use is longer. METHOD: A meta-analysis was conducted of clinical trials of AP that reported weight change. Outcome measures were body weight change, change in BMI and clinically relevant weight change (7% weight gain or loss). Duration of AP-use was stratified as follows: ≤6 weeks, 6-16 weeks, 16-38 weeks and >38 weeks. Forest plots stratified by AP as well as by duration of use were generated and results were summarised in figures. RESULTS: 307 articles met inclusion criteria. The majority were AP switch studies. Almost all AP showed a degree of weight gain after prolonged use, except for amisulpride, aripiprazole and ziprasidone, for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP. CONCLUSION: Given prolonged exposure, virtually all AP are associated with weight gain. The rational of switching AP to achieve weight reduction may be overrated. In AP-naive patients, weight gain is more pronounced.