Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027066 (myoclonus)
 4,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We reported anesthetic as well as perioperative management for a patient with Creutzfeldt-Jakob disease, a very rare transmissible neuropathy. A 51 year-old woman was scheduled for extirpation of recurrence of acoustic neurinoma. Three months before the operation, she had complained vertigo. After admission to our hospital, she had become progressively dementiated and developed disturbed consciousness. Anesthesia was induced with thiamylal and maintained with 0.7-1.5% isoflurane, nitrous oxide and oxygen. The anesthetic course was uneventful and the recovery from anesthesia was smooth. Postoperatively dementia progressed and myoclonus of extremeties appeared sixth weeks after the operation. Two months after the operation, a diagnosis of Creutzfeldt-Jakob disease was established by characteristic EEG and clinical course. Anesthesia for a patient with dementia was discussed.
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PMID:[Anesthesia for a patient with Creutzfeldt-Jakob disease]. 777 22

Propofol is a relatively new anesthetic agent used in outpatient surgery. Some investigators use it in the treatment of status epilepticus and in epilepsy surgery and have concluded that propofol has an anticonvulsant effect. Cases of seizure-like behaviors, myoclonus and opisthotonus following propofol anesthesia have been reported. Although rare, official warnings about this association have been issued. Different EEG abnormalities, and no abnormality, have been associated with propofol. We report a case of a healthy man who developed nonconvulsive seizures and generalized paroxysmal fast activity in his EEG following use of propofol for anesthesia.
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PMID:Propofol, seizures and generalized paroxysmal fast activity in the EEG. 808 14

Bolus doses of propofol in patients for cardioversion often produce hypotension and apnea. Etomidate provides cardiovascular stability in these patients, but myoclonus may interfere with electrocardiographic interpretation. This study was designed to demonstrate whether propofol, when given as a low-dose infusion, can attain etomidate's hemodynamic stability without its attendant side effects. Forty consenting patients were randomly assigned to receive either propofol infusion (50 mg/min) for induction of anesthesia followed by a maintenance infusion (100 micrograms.kg-1.min-1) or etomidate (8 mg/min and 20 micrograms.kg-1.min-1). Calculation of loading infusion rates for propofol and etomidate resulted in averages of 0.64 mg.kg-1.min-1 (range, 0.39-1.04) and 0.09 mg.kg-1.min-1 (range, 0.05-0.14), respectively. Induction times (2.2 min) and the times from terminating drug administration to awake states (4.5 min) were similar for each group. Etomidate produced myoclonus in 45% of the patients; otherwise side effects were minimal, with no significant differences between groups. The means of systolic blood pressures in the etomidate group rose a maximum of 15.3 +/- 7.9% (95% confidence), while a modest decrease of 7.2 +/- 7.3% occurred with propofol. Administration of propofol by infusion for cardioversion retains all its beneficial qualities while attenuating its hypotensive effects, making it a suitable choice for these patients with cardiac arrhythmias.
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PMID:A comparison of propofol and etomidate for cardioversion. 821 50

Excitatory movements have been observed during induction of anesthesia with etomidate, thiopental, methohexital, and propofol. We studied the frequency of these excitatory effects and correlated movements with electroencephalographic (EEG) findings in 67 unpremedicated patients (mean age 66.1 yr, range 45-82 yr). Excitatory effects, including myoclonus, tremor, and dystonic posturing, occurred in 86.6% of patients receiving etomidate; 69.2% of the patient responses were myoclonic. Multiple spikes appeared on the EEG in 22.2% of the etomidate patients. The frequency of excitatory effects was 16.6% after thiopental, 12.5% after methohexital, and 5.5% after propofol. None of the patients receiving thiopental, methohexital, or propofol developed myoclonic or seizure activity. In most patients, the excitatory movements were coincident with the early slow phase of the EEG which corresponds to the beginning of deep anesthesia. We conclude that perhaps caution should be exercised when administering etomidate to patients with a history of seizures as the myoclonic activity is associated with seizure activity. The incidence of excitatory movements after administration of propofol is very low.
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PMID:Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol. 821 99

We gave anesthesia to a 60-year-old female patient in stage III (end stage) of Alzheimer's disease for sigmoidectomy. She had myoclonus and parkinsonism and it was not possible to communicate with her verbally. After induction of anesthesia with thiopental, she had a catheter inserted into epidural space. Without endotracheal intubation, anesthesia was maintained with nitrous oxide, oxygen and isoflurane under spontaneous ventilation supplemented with mepivacaine from the epidural catheter. No muscle relaxant was used. Recovery from the anesthesia was uneventful. No complication was observed during anesthesia and postoperatively.
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PMID:[Anesthetic management of a patient with Alzheimer's disease]. 835 Apr 71

The use of etomidate as an anaesthetic induction agent has been hampered significantly by unwanted side effects such as pain on injection and thrombophlebitis. Investigations by Doenicke et al. have shown that the solubilizer propylene glycol is responsible for these side effects and that they can be avoided by the use of a lipid emulsion formulation. It was the goal of the present study to quantitate the reduction of thrombophlebitis and pain on injection following both formulations under double-blind study conditions. METHODS. In 100 patients anaesthesia was induced either with a new galenic formulation of etomidate--etomidate in lipid emulsion formulation (Lipofundin MCT 20%; eto-lip)--or with etomidate in propylene glycol 35% (eto-pg). Both groups received 0.3 mg kg-1 etomidate in double-blind randomized fashion. After the injection of etomidate the venous cannula was removed. The observing anaesthetist was unaware of the study drug used, to guarantee blinded investigation conditions. Discomfort and pain during and following injection were recorded, as was local skin irritation. Venous sequelae were assessed for 7 days following injection to register the occurrence of thrombophlebitis. RESULTS. Demographic data were not different between the two groups. For induction of anaesthesia the same dose of both preparations was necessary, and no difference in heart rate and blood pressure before, during or after anaesthesia induction was observed. Pain on injection (78% vs 14%), myoclonus (24% vs 8%) and local skin reaction (50% vs 6%) were present significantly more often in the eto-pg group (P < 0.01; P < 0.05 respectively, chi-square test) than in the eto-lip group. On the 1st and 2nd postoperative days, examination of the injected vein revealed a significantly higher incidence of symptoms of thrombophlebitis in the group treated with eto-pg (25% vs 3%). CONCLUSION. From these results it is concluded that in terms of vein compatibility the new galenic formulation of etomidate with lipofundin MCT 20% is superior to the propylene glycol preparation while pharmacodynamic properties seem not to be affected.
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PMID:[Anesthesia induction using etomidate in a lipid emulsion]. 848 91

The mechanism by which 12 atm abs of a helium-oxygen gas mixture (heliox) antagonizes behavioral effects of ethanol is unknown. Although the threshold for pressure-reversal of general anesthesia and expression of the high pressure neurologic syndrome (HPNS) is well above 12 atm abs in mice, the ethanol antagonism by 12 atm abs heliox could result from similar underlying excitatory effects. To investigate this possibility, the behavior of water-injected control mice and the latency to convulsions in drug-injected mice were determined in 1 atm abs air and 12 atm abs heliox. Four convulsant drugs were tested: picrotoxin (2 mg/kg), dl-allylglycine (300 mg/kg), isoniazid (300 mg/kg), and l-methionine-dl-sulfoximine (170 mg/kg). Responses were videotaped to observe behavior and to measure latency to the onset of myoclonus and clonus. Results indicated no observable excitatory effects of 12 atm abs in control mice. The latency to myoclonus was significantly reduced by pressure in allylglycine-treated mice but not in mice treated with the other convulsants. Latency to clonus was not significantly altered by pressure, relative to latency at 1 atm abs heliox, for any drug tested. In conclusion, the present findings indicate that exposure to 12 atm abs heliox is not proconvulsant and, thus, the findings do not support the hypothesis that 12 atm abs heliox antagonizes ethanol indirectly via an increase in central nervous system excitability.
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PMID:Effect of 12 atmospheres helium-oxygen on the response of mice to convulsant drugs. 865 64

Generalized clonic and tonic seizure-like movements were observed during emergence from anesthesia with sevoflurane in a 32-year-old man. The movements lasted 40 sec and necessitated no therapy. There were no significant effects of the incident on the cardiovascular system, such as hypotension, arrhythmia or bradycardia. No neurological abnormalities were obvious after the anesthesia. The movements may have been the result of seizure activity in the central nervous system, or myoclonus of the whole body.
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PMID:Postoperative seizure-like activity following sevoflurane anesthesia. 890 34

Case-1: A 4 month old, 7120 g, girl with hydrocephalus underwent endoscopic fenestration of the septum pellucidum. Her development had been normal without signs or symptoms of intracranial hypertension. She had no history of convulsion or apnea. Ventriculoscopic diagnosis was complete obstruction of the right foramen of Monro and partial defect of right ependyma. Intraoperative course was uneventful under general anesthesia. She had two episodes of respiratory arrest accompanied with myoclonus and the left conjugate deviation 15 min after extubation. Postoperative CT scan showed no abnormal findings such as intracranial hemorrhage. The respiratory arrest and conjugate deviation disappeared after phenobarbital administration. She had no further respiratory arrest. Case-2: A 1-month old boy with congenital hydrocephalus underwent endoscopic third ventriculostomy. He had no signs or symptoms of intracranial hypertension. CT scan showed enlargement of lateral ventricle and third ventricle due to aqueductal stenosis. Respiratory arrest was noted 10 min after extubation in the recovery room. His anterior fontanel sank abnormally and rigidity of the extremities was observed. His trachea was reintubated and he was transferred to ICU. After 24 h of respiratory care in the ICU he was extubated and discharged to the ward. He had no further episodes of respiratory arrest. We believe that postanesthetic apnea monitoring is mandatory in young infants who undergo ventriculoscopic surgery.
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PMID:[Respiratory arrest after a ventriculoscopic surgery in infants: two case reports]. 909 21

Currently, there is no one drug that is the agent of choice for induction in rapid sequence intubation in the emergency department (ED). All agents currently used as induction agents in the ED offer distinct advantages for various clinical conditions, but each has a significant side effect profile and specific contraindications that limit its use in many common clinical settings. A review of the data available from the anesthesia literature suggests that etomidate possesses many properties that may make it the agent of choice for rapid sequence intubations in the ED. These advantages include excellent pharmacodynamics, protection from myocardial and cerebral ischemia, minimal histamine release, and a hemodynamic profile that is uniquely stable. Disadvantages include a lack of blunting of sympathetic response to intubation, a high incidence of myoclonus, prominent nausea and vomiting, potential activation of seizures in patients with epileptogenic foci, and impaired glucocorticoid response to stress. Further studies are needed to evaluate the advantages and disadvantages of the use of etomidate for rapid sequence intubation in the ED.
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PMID:A review of etomidate for rapid sequence intubation in the emergency department. 961 Sep 85


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