ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveDespite a history of widespread use, the utility of lidocaine as an antiarrhythmic and antifibrillatory agent is questionable. The objective of this article is to examine the theoretical basis for the use of lidocaine in light of recent experimental and clinical data. This article reviews the effects of lidocaine on: a) ventricular arrhythmias under ischemic and nonischemic conditions; b) the energy and current requirements for defibrillation; and c) the propensity for asystole during cardiac arrest.DesignA contemporary review of the literature.FindingsThere appears to be a theoretical basis for the use of lidocaine in treating ventricular arrhythmias secondary to acute ischemia largely based on voltage- and pH-dependent binding and inactivation of sodium channels by lidocaine under ischemic conditions. However, clinical and experimental data failed to establish enhanced survival following prophylactic treatment for acute ischemic events or when treatment is administered during cardiac arrest. Moreover, there are no data supporting the use of lidocaine in treating sustained and life-threatening ventricular arrhythmias in the absence of acute ischemia. Experimental data demonstrate that lidocaine can reduce countershock efficacy, i.e., increase the current and energy requirements for defibrillation. Experimental and clinical data suggest that the administration of lidocaine increases the propensity for asystole during cardiac arrest.ConclusionsWhile lidocaine may possess an antifibrillatory effect under experimental conditions, the clinical relevance of such an effect is questionable. If cardiac arrest occurs, lidocaine has limited utility and may be deleterious secondary to diminished countershock efficacy or lidocaine-induced asystole. Reconsideration of the use of lidocaine should be included in future guidelines for management of cardiac arrest.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Lethal catatonia and neuroleptic malignant syndrome are both rare and life-threatening problems. The clinical presentations are very similar, with striking features of altered mental status, fevers, and muscle rigidity.Lethal catatonia is a neuropsychiatric disorder that was first described in the early 1800s, 100 yrs before the use of neuroleptics and other antipsychotic agents. Presently, it appears that this disorder may be an extension and terminal event of excited catatonia. Modern psychopharmacologic practice has almost eliminated this lethal progression. This syndrome is most commonly associated with underlying psychiatric pathology, but may rarely be associated with organic disease. Severe hyperthermia is one of the most striking changes that occurs with lethal catatonia along with a wide spectrum of abnormal behavior, including severe lability of mood, anorexia, bizarre behavior, hallucinations, mutism, catatonia, and muscle rigidity. Hyperthermia may culminate in death secondary to dehydration, end-organ failure, and cardiovascular collapse if it is unrecognized or refractory to therapy. Therapy consists of aggressive supportive therapy, antipsychotic agents, and, on occasion, electroconvulsive therapy (1).The neuroleptic malignant syndrome is an uncommon, but severe, adverse reaction to antipsychotic and neuroleptic medications. Neuroleptic malignant syndrome is characterized by high fever, muscle rigidity, autonomic dysfunction, and an alteration in the level of consciousness. Patients frequently have increased WBC counts and serum creatinine phosphokinase (CPK) concentrations. Neuroleptic malignant syndrome is reported to have a mortality rate of approximately 20%. The syndrome is a diagnosis of exclusion and must be differentiated from lethal catatonia, infectious etiologies, central nervous system pathology, malignant hyperthermia, toxic encephalopathy, hyperthyroidism, tetany, parkinsonism, and drug overdose or toxin ingestion (2–5).We present a patient who developed lethal catatonia, which was initially, successfully treated with an antipsychotic drug. However, the patient subsequently developed neuroleptic malignant syndrome. The diagnostic dilemma and therapeutic challenges of this clinical situation are reviewed.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Lethal catatonia, a life-threatening, febrile neuropsychiatric disorder, was reported before the introduction of modern psychopharmacologic treatment. Kraepelin (1) discussed this disorder as a syndrome that comprises a characteristic cluster of symptoms, such as catalepsy, negativism, posturing, muscular rigidity, and verbigeration. In order to assess the current status of lethal catatonia, Mann et al. (2) identified a series of 292 cases reported since 1960.The recognition that lethal catatonia is a well-defined neuropsychiatric syndrome that occurs during the course of both organic and functional psychiatric illnesses has major clinical implications (3).Electroconvulsive therapy is the treatment of choice for lethal catatonia. Dantrolene sodium therapy presents an important advance in the therapy of sometimes life-threatening hypercatabolic disorders associated with muscle spasticity (4, 5).We report a case of apparent lethal catatonia in a 39-yr-old male psychiatric patient with a hypercatabolic disorder accompanied by muscle spasticity.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID