Author(s): Hughes L.; Anderson E.

Source: Anaesthesia; Jul 2019; vol. 74 ; p. 79

Publication Date: Jul 2019

Publication Type(s): Conference Abstract

Available  at Anaesthesia –  from Wiley Online Library Full Collection

Available  at Anaesthesia –  from Unpaywall

Abstract:Peri-operative dystonic reactions are rare. Dystonic reactions to ondansetron have been described [1]. Ondansetron is routinely administered to prevent postoperative nausea and vomiting, with few observed side effects. Description A fit and well 21-year-old female patient underwent routine tonsillectomy for recurrent tonsillitis. She had taken a long time to wake from a general anaesthetic as a child. She was induced with fentanyl, propofol and atracurium. Ondansetron was given to prevent postoperative nausea and vomiting. The operation proceeded uneventfully and she was extubated in theatre. In theatre recovery, she displayed dystonic movements of her limbs, and it was noted that she had sustained upward deviation of her eyes. A diagnosis of oculogyric crisis, likely secondary to ondansetron was made. She was given midazolam for anxiety, followed by procyclidine. She fell asleep, but on waking her symptoms resumed. Further doses of procyclidine and midazolam were given. She was later given levetiracetam. Full resolution of her symptoms was observed by 8 h, and she was discharged home the following day. She was advised to inform the anaesthetists of this reaction for any further operations. Discussion Acute dystonic reactions can include involuntary movements, abnormal posturing, oculogyric crisis and dysarthria. The exact cause of ondansetron-induced extra-pyramidal side effects is unknown. Due to the action of ondansetron on serotonergic receptors, traditional treatment for extra-pyradmidal side effects may not work as effectively [1, 2]. Our patient was given both procyclidine and midazolam, which improved her symptoms, but complete resolution of her symptoms did not occur until 8 h. It is important for anaesthetists to be aware of this uncommon side effect of ondansetron, and the natural progression and resolution of symptoms.

Database: EMBASE