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首页> 外文期刊>The Internet Journal of Neurology >Letter to the Editor: Extrapyramidal Drug Reactions Due To A Piperazine Derivative
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Letter to the Editor: Extrapyramidal Drug Reactions Due To A Piperazine Derivative

机译：致编辑的信：哌嗪衍生物引起的锥体外系药物反应

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Sir:Cyclizine is a Piperazine derivative, with both antihistaminic and antimuscarinic effects; the latter must be responsible for most of it's antiemetic effects and has been considered to have no extra pyramidal effects. However I came across a case of involuntary head jerking and fixed gaze. I would like to describe a patient in whom an episode of extra pyramidal reaction developed after receiving 50 mg of cyclizine after induction of Anaesthesia.A 38-year-old man weighing 70 kg with an otherwise unremarkable medical history was scheduled for application of 6-hole plate for fracture Radius. The vital signs and physical examination were normal. Patient was taking no medications at home and denied any drug allergy.Anaesthesia was induced with 200 mg of Propofol and 100 microgram of intravenous fentanyl. Size 4 LMA was inserted and patient was allowed to breathe spontaneously. He also received 10 mg of morphine. Cyclizine 50 mg was given intravenously for prophylaxis against postoperative nausea and vomiting. Patient was given 40% oxygen and 60% Nitrous oxide. Isoflurane was used for maintenance of anaesthesia.Surgery went on for 45 minutes. Postoperatively patient was taken to recovery. Ten minutes later patient developed involuntary jerking movements of his upper half of body. On examination of patient; his vital parameters were normal and he was responding to verbal commands. His gaze was fixed. I reassured the patient. These movements continued for next 7-8 minutes and then it stopped and patient became comfortable. His gaze became normal. No intervention was required. Rest of the postoperative period was uneventful. Extrapyramidal drug reactions have been reported to various antiemetics; like phenothiazines (e.g. prochlorperazine), antihistaminics (diphenhydramine), dopamine antagonists (e.g. metoclopramide) and 5-HT antagonists (e.g. ondansetron).There are case reports of involuntary movements following propofol or fentanyl anaesthesia. Dystonic activity is a recognized complication of administration of cyclizine.
机译：主席先生：环丙嗪是哌嗪衍生物，具有抗组胺和抗毒蕈碱作用;后者必须负责其大部分止吐作用，并且被认为没有额外的金字塔效应。但是，我遇到了一个非自愿的头部抽搐和凝视的情况。我想描述一名患者，在麻醉诱导后接受50 mg的环利嗪后，发生了额外的锥体反应发作。一名38岁，体重70公斤，病史不明显的男子计划应用6-孔板的断裂半径。生命体征和身体检查均正常。患者在家中不服药，对药物没有过敏反应。异丙酚200 mg和静脉注射芬太尼100 mg麻醉。插入4号LMA，让患者自发呼吸。他还接受了10毫克吗啡。静脉给予50 mg的Cyclizine预防术后恶心和呕吐。给予患者40％的氧气和60％的一氧化二氮。异氟烷用于维持麻醉，手术进行了45分钟。术后患者被恢复。十分钟后，患者上半身出现了不自主的抽搐动作。对病人进行检查;他的生命参数正常，并且正在回应口头命令。他的目光是固定的。我向病人保证。这些运动持续了接下来的7-8分钟，然后停止了，患者感到舒适。他的目光变得正常。无需干预。其余的手术时间都很顺利。锥体外系药物反应已被报道为各种止吐药。例如吩噻嗪（例如氯丙嗪），抗组胺药（苯海拉明），多巴胺拮抗剂（例如甲氧氯普胺）和5-HT拮抗剂（例如恩丹西酮）。肌张力障碍活性是施用环嗪的公认并发症。

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