Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026837 (muscle rigidity)
 1,077 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied three groups of 30 patients each, undergoing minor orthopaedic surgery, anaesthetized with alfentanil (30 micrograms/kg bolus followed by an infusion of 0.3 micrograms/kg/min), thiopental 3 mg/kg and 70% N2O via facial mask. Patients in group I were treated, three minutes before induction, with vecuronium 0.02 mg/kg i.v., while those in group II were premedicated with diazepam 0.15 mg/kg i.m. 30-45 minutes before induction. Group III served as control. Muscular rigidity was evaluated clinically with a subjective score based on a scale of 0 (no rigidity) to 3 (severe rigidity). Diazepam did not give significant protection from muscular rigidity. Vecuronium administration did not significantly reduced the number of patients who became rigid, but significantly decreased the incidence of severe rigidity (p less than 0.005), the mean rigidity score (p less than 0.05) and the incidence of rigidity at the induction of anaesthesia (p less than 0.0005). We also observed a progressively increasing incidence of rigidity with increasing age (not significantly) and body weight (p less than 0.05 total rigidity, p less than 0.01 severe rigidity).
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PMID:[Muscular rigidity caused by alfentanil: prevention]. 257 21

Alfentanil mask anaesthesia was performed in 63 patients undergoing termination of pregnancy or curettage. Three different types of premedication were used: a) pethidine, promethazine, and atropine; b) diazepam and atropine; c) atropine. The patients were ventilated either with nitrous oxide and oxygen or with halothane and oxygen. Halothane reduced the frequency of muscular rigidity (32%; N2O 75%), postoperative sickness, and vomiting (23%; N2O 50%). On the other hand, patients regained consciousness earlier if nitrous oxide was used. Premedication a) also reduced the frequency of nausea and emesis (21%; other premedications 63%).-Alfentanil intubation anaesthesia was performed in 52 patients undergoing laparoscopy. Premedication and inhalation anaesthetic varied as described above in the group with mask anaesthesia. Muscular rigidity did not occur, and nausea/emesis were rare events (8%). Halothane prolonged the recovery phase of consciousness and respiration. Premedication a) also resulted in respiratory depression.
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PMID:[Influence of various premedication agents, inhalation anesthetics and adjuvants on anesthesia with an opioid, alfentanyl]. 286 27

The potency and anesthetic state produced by nitrous oxide alone were investigated in order to clarify its contribution to the effect of other anesthetic agents. Seven volunteers anesthetized with 1.55 atm absolute N2O in a pressure chamber displayed muscle rigidity with jerking movements, labored and rapid breathing, sweating, and dilated pupils. At 1.1 atm absolute N2O, relaxation and quiescence occurred, sweating ceased, and pupil size decreased. Determination of MAC (using tetanic electrical impulses as the noxious stimulus) produced a mean value of 1.04 +/- 0.10 (SE) atm absolute. All subjects complained of nausea and vomiting after anesthesia.
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PMID:The minimum alveolar concentration of nitrous oxide in man. 720 Dec 54

Muscle rigidity is a side effect of potent opiate agonists like alfentanil. Older clinical studies suggested that nitrous oxide (N2O) augments opiate rigidity, but this has never been rigorously examined in an animal model. Sixty-two Wistar rats were placed in a Plexiglas box through which fresh gas flowed at 4 l/min. Muscle rigidity was assessed using gastrocnemius electromyographic (EMG) activity. Rats were exposed to either 60% N2O in O2 or 100% O2, EMG was measured for 10 min, alfentanil (0, 50, 175, or 350 micrograms/kg) was administered intravenously, and data were collected for 45 min. Alfentanil produced a dose-dependent increase in EMG activity in both O2 and N2O groups (p < 0.001). At 1 min postalfentanil, N2O caused significantly more rigidity than 100% O2 (p < 0.001). However, beginning at 5 min, N2O attenuated both the magnitude and the duration of rigidity. Study of a separate group of animals breathing 30% O2 demonstrated that N2O's attenuating effect on alfentanil rigidity was not due to reduced inspired oxygen concentration. These results are described by a theoretical model of the pharmacodynamic interactions of alfentanil and nitrous oxide.
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PMID:Nitrous oxide produces a biphasic effect on opiate-induced muscle rigidity in the rat. 761 73

We report two boys aged 4 and 10 months who suffered cardiac arrests after induction of anaesthesia. Both infants had no personal or family history of myopathy. In both cases anaesthesia was induced by inhalation with halothane and N2O/O2 (70/30). To facilitate tracheal intubation both were given succinylcholine after the administration of atropine. The 4-month-old developed muscle rigidity and cardiac arrest occurred immediately after tracheal intubation. Resuscitation was unsuccessful. Laboratory findings during resuscitation showed elevated serum potassium levels of more than 10 mmol/l and serum creatine phosphokinase 17.700 IU/l. Histopathologic examination of the skeletal muscle revealed congenital muscular dystrophy. In the older boy no muscle contractures were noted after administration of succinylcholine. He developed bradycardia that progressed to asystole 15 min after induction of anaesthesia. After 1 h of resuscitation a sinus rhythm could be established. The boy developed myoglobinuria and his serum creatine phosphokinase reached a maximum level of 45,000 IU/l on the 2nd day. The child survived and made a complete recovery. Two months later a muscle biopsy taken from the quadriceps showed marked muscular dystrophy. Duchenne's muscular dystrophy could be excluded. The most likely underlying reasons for these complications are discussed: anaesthesia-induced acute rhabdomyolysis or malignant hyperthermia.
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PMID:[Anesthetic-induced heart arrest. A case report of 2 infants with previously unrecognized muscular dystrophy]. 844 72

Tetanus is an acute often fatal disease produced by gram positive obligate anaerobic bacterium Clostridium tetani. Tetanolysin damages local tissue and provides optimal conditions for bacterial multiplication. It is therefore important to perform a wide debridement of any wound suspected of being a portal of entry for the bacteria. Little evidence exists to recommend specific anesthetic protocols. We encountered a child scheduled for fracture both bone forearm with developing tetanus. Initial management done with intravenous (i.v) diazepam, phenobarbitone, and metronidazole. After premedication with midazolam and fentanyl, induction was done by propofol 60 mg, vecuronium 2.5 mg, ventilated with O2+ N2O 50:50 with sevoflurane 2% and tracheal intubation was done with 5.5 ID cuffed PVC endotracheal tube. Anesthesia was maintained with sevoflurane 2% and vecuronium intermittently when required. Intraop vitals were stable. On completion of surgery, reversal given and patient was extubated uneventfully and shifted to recovery room. Little evidence exists to recommend specific anesthetic technique for tetanus patient posted for surgery. When present, obvious wounds should be surgically debrided. Ideally patients considered for surgery should undergo anesthesia and surgery before severe autonomic dysfunction develops. Most anesthetic managements are based on limited evidence. However, we used sevoflurane and vecuronium successfully, further study is needed to establish their efficacy and safety. Major challenges lie in the control of muscle rigidity and spasm, autonomic disturbances and prevention of complications.
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PMID:General anesthesia in tetanus patient undergoing emergency surgery: A challenge for anesthesiologist. 2588 14