Central Journal of ISA

Anjum Naz ¹, Bivash Halder ¹, Prithviraj Chakraverty ¹, Avishek Naha ¹, Nivedita Mukherjee ¹

Affiliations
1 Department of Anaesthesiology and Intensive Care, KPC Medical College and Hospital, Kolkata, West Bengal, IN

Abstract

Opioid induced muscle rigidity and myoclonus is a frequently described complication which occurs more commonly with large doses and rapid administration of the drugs and is observed at the time of induction. In the post-operative period this complication is reported in patients undergoing cardiac surgery, where large dosages of fentanyl or analogs are employed. Rigidity and myoclonus in the postoperative period with analgesic doses of opioids is extremely rare. We report a case where a life threatening chest wall rigidity and myoclonus occurred in a patient where fentanyl was used as an intraoperative analgesic in a relatively low dose. Though the mechanism of occurrence of this phenomenon remains unclear but the fact that the rigidity was terminated with naloxone confirms that it was fentanyl induced.

Keywords

Chest Wall Rigidity, Fentanyl, Myoclonus, Naloxone, Post-Operative.

Full Text

   

Anjum Naz ¹, Arcojit Ghosh ¹

Affiliations
1 Department of Anaesthesiology, KPC Medical College, Kolkata, IN

Abstract

Intravenous fluid therapy is vital for resuscitation of critically ill patients. However, the procedure is very complex; the standards of operation and monitoring are controversial and the indications of commencement and weaning are fiercely debated. Administration of intravenous fluids is imperative for circulatory stabilization and is potentially lifesaving in shock patients; on the other hand it can be the cause of increased morbidity and mortality if there is a volume overload. Crystalloids and colloids are the two types of fluids which can be used for resuscitation; and each one is associated with its own set of benefits and adverse effects. The population of critically ill patients is significantly heterogeneous, thus the targets, and safety limits cannot be clearly defined which can be applied to all the patients in Intensive Care Unit patients (ICU) alike. The fluids should be considered as any other intravenous drug in ICU with an optimal dose and a therapeutic and toxic window. The amount and the type of Intravenous (IV) fluids used play a crucial role in patient outcome and need to be individualized. The patients who are responsive to fluid resuscitation initially are susceptible to overload later so it is very crucial to know when to stop IV fluids. The monitoring which is generally used in ICU and the static measures of fluid responsiveness are not sufficient to guide the fluid therapy in critically ill patients. Dynamic measures to predict the fluid responsiveness can be helpful to prevent excessive fluid administration.

Keywords

Fluid Therapy, Intensive Care, Resuscitation, Volume Overload.

Full Text