Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous ...Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally implanted pump. While ideal for long-term attenuation of symptoms, this treatment modality can also become disastrous should the pump empty and withdrawal subsequently ensue. Case Report: A 48-year-old male with a past medical history of T8 spinal cord injury from a motor vehicle crash originally presented with altered mental status. Because of resultant paraplegia and spasticity from his injuries, a neurosurgeon implanted an intrathecal baclofen pump three years prior to presentation with symptomatic relief. Further exploration revealed that he had missed his scheduled pump refill appointment and interrogation of his pump confirmed a completely empty reservoir. The patient endured a protracted hospital course that included rhabdomyolysis, acute renal failure, lactic acidosis, respiratory failure, and systemic inflammatory response syndrome. Treatment included benzodiazepines, dantrolene, aggressive hydration, opiates, and refill of his intrathecal baclofen pump. His mentation and ventilatory status improved with recovery from his critical illness and eventual discharge. Conclusions: Treatment of intrathecal baclofen withdrawal should focus on restoration of previous intrathecal baclofen levels by refill of the intrathecal pump. Adjuvant medications such as benzodiazepines, propofol, cyproheptadine, dantrolene, tizanidine, and opiates may prove crucial in helping with muscle spasticity while these levels are reestablished. A high index of suspicion, leading to timely initiation of proper treatment, may serve as the most important factor in successful recovery from this life-threatening syndrome.展开更多
目的分析鞘内泵入吗啡药物不良反应(ADR)的规律及特点,为临床合理用药提供参考。方法检索中国知网、万方、维普、PubMed、Web of Science等数据库中鞘内泵入吗啡致ADR的文献,检索时限均为从建库至2021年5月31日。对患者一般疾病情况、AD...目的分析鞘内泵入吗啡药物不良反应(ADR)的规律及特点,为临床合理用药提供参考。方法检索中国知网、万方、维普、PubMed、Web of Science等数据库中鞘内泵入吗啡致ADR的文献,检索时限均为从建库至2021年5月31日。对患者一般疾病情况、ADR的发生时间、临床表现、处理及转归等进行汇总分析。结果共纳入文献31篇,病例37例;61~70岁(13例,35%)的例数最多;植入鞘内吗啡泵后12个月内ADR出现最多(17例次,35%);ADR累及多个系统,其中全身性疾病及用药部位反应的发生率最高(29例次,60%),呼吸系统反应最为严重(1例次,2%)。结论临床应重视鞘内泵入吗啡所致的ADR,应用时考虑患者年龄、使用时间等因素,并关注全身性疾病及用药部位反应等系统的临床表现,确保患者安全有效用药。展开更多
文摘Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally implanted pump. While ideal for long-term attenuation of symptoms, this treatment modality can also become disastrous should the pump empty and withdrawal subsequently ensue. Case Report: A 48-year-old male with a past medical history of T8 spinal cord injury from a motor vehicle crash originally presented with altered mental status. Because of resultant paraplegia and spasticity from his injuries, a neurosurgeon implanted an intrathecal baclofen pump three years prior to presentation with symptomatic relief. Further exploration revealed that he had missed his scheduled pump refill appointment and interrogation of his pump confirmed a completely empty reservoir. The patient endured a protracted hospital course that included rhabdomyolysis, acute renal failure, lactic acidosis, respiratory failure, and systemic inflammatory response syndrome. Treatment included benzodiazepines, dantrolene, aggressive hydration, opiates, and refill of his intrathecal baclofen pump. His mentation and ventilatory status improved with recovery from his critical illness and eventual discharge. Conclusions: Treatment of intrathecal baclofen withdrawal should focus on restoration of previous intrathecal baclofen levels by refill of the intrathecal pump. Adjuvant medications such as benzodiazepines, propofol, cyproheptadine, dantrolene, tizanidine, and opiates may prove crucial in helping with muscle spasticity while these levels are reestablished. A high index of suspicion, leading to timely initiation of proper treatment, may serve as the most important factor in successful recovery from this life-threatening syndrome.
文摘目的分析鞘内泵入吗啡药物不良反应(ADR)的规律及特点,为临床合理用药提供参考。方法检索中国知网、万方、维普、PubMed、Web of Science等数据库中鞘内泵入吗啡致ADR的文献,检索时限均为从建库至2021年5月31日。对患者一般疾病情况、ADR的发生时间、临床表现、处理及转归等进行汇总分析。结果共纳入文献31篇,病例37例;61~70岁(13例,35%)的例数最多;植入鞘内吗啡泵后12个月内ADR出现最多(17例次,35%);ADR累及多个系统,其中全身性疾病及用药部位反应的发生率最高(29例次,60%),呼吸系统反应最为严重(1例次,2%)。结论临床应重视鞘内泵入吗啡所致的ADR,应用时考虑患者年龄、使用时间等因素,并关注全身性疾病及用药部位反应等系统的临床表现,确保患者安全有效用药。
