RESUMEN
BACKGROUND: Gabapentin is the most commonly preferred agent for neuropathic pain in general practice as it is usually well tolerated, but occasionally, its toxicity may occur at standard doses, especially in elderly individuals, even without any prior comorbidities. CASE: We present an elderly male with normal renal parameters, who was started on gabapentin for neuropathic pain. He developed multifocal myoclonus all over the body within few days after starting gabapentin and subsided completed after withdrawal of the drug. CONCLUSION: Acute hyperkinetic movement disorders such as multifocal or segmental myoclonus in elderly patients warrant a prompt review of recent drug history, especially gabapentin, even in the background of normal renal function.
Asunto(s)
Analgésicos , Gabapentina , Mioclonía , Humanos , Gabapentina/efectos adversos , Masculino , Mioclonía/inducido químicamente , Analgésicos/efectos adversos , Neuralgia/tratamiento farmacológico , Anciano , Ácido gamma-Aminobutírico/efectos adversos , Aminas/efectos adversosRESUMEN
Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.
Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Albuterol/efectos adversos , Agonistas de Receptores Adrenérgicos beta 2/efectos adversos , Mioclonía/inducido químicamente , Terapia por Inhalación de Oxígeno , Metilprednisolona/uso terapéutico , Ipratropio/uso terapéutico , Resultado Fatal , Terapia Combinada , Trastornos Relacionados con Sustancias/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Albuterol/uso terapéutico , Sinergismo Farmacológico , Quimioterapia Combinada , Urgencias Médicas , Fenoterol/efectos adversos , Fenoterol/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéuticoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Mioclonía/inducido químicamente , Mioclonía/complicaciones , Medicamentos Compuestos contra Resfriado, Gripe y Alergia/efectos adversos , Dextrometorfano/efectos adversos , Clorfeniramina/uso terapéutico , Acetaminofén/efectos adversos , Ácido Ascórbico/efectos adversos , Benzodiazepinas/uso terapéutico , Receptores de GABA-A/uso terapéutico , Farmacovigilancia , Discinesias/complicaciones , Discinesias/tratamiento farmacológico , Administración Intravenosa/instrumentación , Administración Intravenosa/métodos , Administración IntravenosaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Ciprofloxacina/efectos adversos , Mioclonía/inducido químicamente , Quinolonas/efectos adversos , Factores de RiesgoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Mioclonía/inducido químicamente , Mioclonía/complicaciones , Mioclonía/tratamiento farmacológico , Fentanilo/efectos adversos , Fentanilo/uso terapéutico , Fentanilo/toxicidad , Síndromes de Neurotoxicidad/complicaciones , Factores de Riesgo , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Infecciones del Sistema Respiratorio/complicacionesRESUMEN
Abstract Aim: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. Method: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2 h before the operation were given oral capsules of placebo (Group P, n = 25), 400 mg gabapentin (Group G400, n = 25), 800 mg gabapentin (Group G800, n = 25) or 1200 mg gabapentin (Group G1200, n = 25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3 mg kg−1 etomidate was administered for 10 s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2 µg kg−1 fentanyl and 0.8 mg kg−1 rocuronium were administered for tracheal intubation. Results: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. Conclusion: Pretreatment with 800 mg and 1200 mg gabapentin 2 h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.
Resumo Objetivo: Avaliar os efeitos de três doses diferentes de gabapentina como pré-tratamento sobre a incidência e a gravidade dos movimentos mioclônicos associados à injeção de etomidato. Método: Cem pacientes, entre 18-60 anos, estado físico ASA I-II, programados para cirurgia eletiva sob anestesia geral, foram incluídos no estudo. Os pacientes foram randomicamente divididos em quatro grupos e duas horas antes da operação receberam cápsulas orais de placebo (Grupo P, n = 25), 400 mg de gabapentina (Grupo G400, n = 25), 800 mg de gabapentina (Grupo G800, n = 25) e 1.200 mg de gabapentina (Grupo G1.200, n = 25). Os efeitos colaterais antes da cirurgia foram registados. Após pré-oxigenação para a indução da anestesia, etomidate (0,3 mg.kg−1) foi administrado por 10 segundos. Um único anestesista, cego para a medicação do estudo, avaliou a sedação e os movimentos mioclônicos com uma escala de 0 a 3. Dois minutos após a indução, fentanil (2 µgr.kg−1) e rocurônio (0,8 mg.kg−1) foram administrados para a intubação traqueal. Resultados: Os dados demográficos foram semelhantes. A incidência e a gravidade da mioclonia nos grupos G1.200 e G800 foram significativamente menores do que no Grupo P; a incidência e o nível de sedação foram consideravelmente maiores comparados com o Grupo P e o Grupo G400. Enquanto não houve diferença na incidência de mioclonia entre os grupos P e G400, a gravidade da mioclonia no Grupo G400 foi menor do que no grupo placebo. No período de duas horas antes da indução, nenhum dos efeitos colaterais relacionados à gabapentina, exceto sedação, foi observado em qualquer paciente. Conclusão: O pré-tratamento com 800 mg e 1.200 mg de gabapentina duas horas antes da operação aumentou o nível de sedação e reduziu a incidência e a gravidade dos movimentos mioclônicos associados ao etomidato.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Ácidos Ciclohexanocarboxílicos/farmacología , Etomidato/efectos adversos , Ácido gamma-Aminobutírico/farmacología , Aminas/farmacología , Mioclonía/inducido químicamente , Mioclonía/prevención & control , Índice de Severidad de la Enfermedad , Método Doble Ciego , Anestésicos Intravenosos/efectos adversos , Relación Dosis-Respuesta a Droga , Gabapentina , Persona de Mediana Edad , Anticonvulsivantes/farmacologíaRESUMEN
Myoclonus induced by etomidate during induction of general anesthesia is undesirable. This study evaluated the effect of dexmedetomidine (DEX) pretreatment on the incidence and severity of etomidate-induced myoclonus. Ninety patients undergoing elective surgical procedures were randomly allocated to three groups (n=30 each) for intravenous administration of 10 mL isotonic saline (group I), 0.5 µg/kg DEX in 10 mL isotonic saline (group II), or 1.0 µg/kg DEX in 10 mL isotonic saline (group III) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous push injection. The incidence and severity of myoclonus were recorded for 1 min after etomidate administration and the incidence of cardiovascular adverse events that occurred between the administration of the DEX infusion and 1 min after tracheal intubation was recorded. The incidence of myoclonus was significantly reduced in groups II and III (30.0 and 36.7%), compared with group I (63.3%). The incidence of severe sinus bradycardia was significantly increased in group III compared with group I (P<0.05), but there was no significant difference in heart rate in groups I and II. There were no significant differences in the incidence of low blood pressure among the 3 groups. Pretreatment with 0.5 and 1.0 µg/kg DEX significantly reduced the incidence of etomidate-induced myoclonus during anesthetic induction; however, 0.5 µg/kg DEX is recommended because it had fewer side effects.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anestésicos Generales/efectos adversos , Bradicardia/epidemiología , Dexmedetomidina/administración & dosificación , Etomidato/efectos adversos , Hipnóticos y Sedantes/administración & dosificación , Mioclonía/inducido químicamente , Mioclonía/prevención & control , Presión Sanguínea/efectos de los fármacos , Procedimientos Quirúrgicos Electivos , Frecuencia Cardíaca/efectos de los fármacos , Incidencia , Mioclonía/epidemiología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
El objetivo es presentar un estudio descriptivo relacionado con un caso de de mioclonía espinal (ME) sin precedentes conocidos, tras una anestesia subaracnoidea. Los ME son espasmos no generalizados repentinos, breves e involuntarios que pueden ser un efecto adverso de la administración de fármacos a través de las vías neuroaxiales. Se presenta el caso de una mujer de 67 años, ASA II, propuesta para cirugía de reemplazo de cadera, con exámenes preoperatorios normales en la que 7 minutos después de la anestesia subaracnoidea con 10 mg de bupivacaína al 0,5% no se observó bloqueo motor, y la paciente se quejó de dolor insoportable en las piernas y en el perineo, asociando con movimientos mioclónicos bilaterales, asimétricos y arrítmicos en las extremidades inferiores. El dolor se resolvió tras 48 horas de anestesia general y perfusión de rocuronio, entre otras medidas terapéuticas. Tras el diagnóstico diferencial, la bupivacaína intratecal parece ser la causa más probable de ME, con respecto a la ausencia de trastornos neurológicos y electrolíticos, traumatismo directo de la médula espinal, intercambio de fármacos y examen perioperatorio normal, imágenes y pruebas de laboratorio. Es obligatorio revisar siempre las historias anestésicas de los pacientes y reconocer, tratar y reportar complicaciones anestésicas raras
The goal is to present a descriptive study related an unprecedent case of spinal myoclonus (SM) following subarachnoid anesthesia (SA). SM are sudden, brief, involuntary non-generalized spasms that can be an adverse effect of drug administration via neuraxial routes. Female, 67y, ASA II, proposed for hip replacement surgery, with normal preoperative exams. 7min after SA with 10mg of bupivacaine 0,5%, no motor blockade observed, and patient complained of unbearable pain in legs and perineum and bilateral, asymmetrical and arrhythmic myoclonic movements in the lower limbs. The latter solved after 48h of general anesthesia and rocuronium perfusion, amongst other therapeutics. Accordingly, intrathecal bupivacaine appears to be the SM most likely cause, regarding the absence of neurologic and electrolyte disorders, spinal cord direct trauma, drug exchange and normal perioperative examination, imaging and laboratory testing.It is mandatory to always take the patients' anaesthetic histories and recognize, treat and report rare anaesthetic complications
Asunto(s)
Humanos , Femenino , Anciano , Bupivacaína/efectos adversos , Anestésicos Locales/efectos adversos , Inyecciones Espinales/efectos adversos , Artroplastia de Reemplazo de Cadera , Mioclonía/inducido químicamenteRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adolescente , Mioclonía/inducido químicamente , Factores de Necrosis Tumoral/antagonistas & inhibidores , Psoriasis/tratamiento farmacológico , Tortícolis/inducido químicamente , Factores de RiesgoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Mioclonía/inducido químicamente , Aldicarb/envenenamiento , Intento de Suicidio , Atropina/uso terapéutico , Mioclonía/tratamiento farmacológicoRESUMEN
No dsiponible
Asunto(s)
Humanos , Insuficiencia Renal Crónica/complicaciones , Mioclonía/inducido químicamente , GABAérgicos/efectos adversosRESUMEN
Relatamos um caso de síndrome seretoninérgica pelo uso de inibidor da recaptação da serotonina, a paroxetina. Tal síndrome por esta droga, sem combinações, ainda não tinha sido descrita na literatura.
Asunto(s)
Humanos , Femenino , Adulto , Mioclonía/inducido químicamente , Paroxetina/efectos adversos , Síndrome de la Serotonina/etiología , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversosRESUMEN
No disponible
Asunto(s)
Masculino , Femenino , Anciano , Persona de Mediana Edad , Humanos , Mioclonía/inducido químicamente , Peptidil-Dipeptidasa A/efectos adversos , Hipertensión/tratamiento farmacológico , Enalapril/efectos adversos , Captopril/efectos adversosRESUMEN
Aportamos el caso de una niña de 7 años de edad que presentó un episodio de mioclonías y temblores de pocas horas de duración tras haber ingerido una cantidad no bien determinada de un preparado que contenía antihistamínico y seudoefedrina. Queremos destacar la potencial toxicidad de la seudoefedrina, comercializada en asociación con antihistamínicos y que se vende como fármaco para aliviar el resfriado común y la obstrucción nasal. Dichos productos se consideran medicamentos para tratar síntomas a menudo banales, por lo que pensamos que la población y, con menos frecuencia, los profesionales, pueden infravalorar la potencial toxicidad de los fármacos que los componen (AU)
We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well cuantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potencial toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we cant underestimate the potencial adverse events and toxic effects that can occur when administering these medications We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well cuantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potencial toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we cant underestimate the potencial adverse events and toxic effects that can occur when administering these medications (AU)
Asunto(s)
Humanos , Broncodilatadores/envenenamiento , Efedrina/envenenamiento , Mioclonía/inducido químicamente , Sobredosis de Droga , Temblor/inducido químicamenteRESUMEN
We describe a patient with a longstanding paraplegia who developed spinal myoclonus on 3 different occasions spanning one year, once after an enhanced CT scan and twice after excretory urographies, one of which was also followed by a generalized tonic-clonic seizure. To our knowledge only one case of spinal myoclonus secondary to the administration of intravenous contrast material in a patient with a spinal arteriovenous malformation has yet been reported. Taken together, the findings in these cases suggest that spinal myoclonus following intravenous iodine administration is indicative of an underlying spinal cord lesion.