Gustatory hyperhidrosis is facial sweating usually associated with the eating of hot spicy food or even smelling this food. Current options of treatment include oral anticholinergic drugs, the topical application of anticholinergics or aluminum chloride, and the injection of botulinum toxin. Thirteen patients have been treated to date with 1.5% or 2% topical glycopyrrolate. All patients had gustatory hyperhidrosis, which interfered with their social activities, after transthroacic endoscopic sympathectomy, and which was associated with compensatory focal hyperhidrosis. After applying topical glycopyrrolate, the subjective effect was excellent (no sweating after eating hot spicy food) in 10 patients (77%), and fair (clearly reduced sweating) in 3 patients (23%). All had reported incidents of being very embrasssed whilst eating hot spicy foods. Adverse effects included a mildly dry mouth and a sore throat in 2 patients (2% glycopyrrolate), a light headache in 1 patient (1.5% glycopyrrolate). The topical application of a glycopyrrolate pad appeared to be safe, efficacious, well tolerated, and a convenient method of treatment for moderate to severe symptoms of gustatory hyperhidrosis in post transthoracic endoscopic sympathectomy or sympathicotomy patients, with few side effects.
Administration, Topical ; Adolescent ; Adult ; Cholinergic Antagonists/*administration & dosage ; Endoscopy/adverse effects ; Female ; Glycopyrrolate/*administration & dosage ; Human ; Male ; Sweating, Gustatory/*drug therapy/etiology ; Sympathectomy/adverse effects/methods

Herpes zoster is a relapse of varicella. In certain cases, long-term pain and hyperhidrosis have been noted. Appearance of herpes zoster during pregnancy is infrequent. We described hyperhidrosis and pain treatment using glycopirrolate cream in a pregnant woman with herpetic neuralgia. A 32 year old woman, 21 weeks pregnant with second child, complained to her gynecologist of the appearance of a vesicular rash on the left half of the forehead that progressed toward her left eyelid, accompanied by lancinating pain, allodynia, hyperhidrosis and small edema, blepharitis and conjunctivitis. Following clinical and laboratory tests, she was diagnosed with herpes zoster ophtalmicus. Aciclovir therapy was administered 800 mg orally five times daily for seven days. Pain therapy was initiated with amitriptilline. We discontinued amitriptilline therapy after 10 days because of appearance of unwanted side effects. After skin changes ceased, we introduced Lidocaine patch into pain therapy which reduced the allodynia, but not the lancinating pain and hyperhidrosis. At that time we began using glycopirrolate cream which reduced pain intensity by 28.5% within 24 hours, and completely eliminated hyperhidrosis. After 48 hours of use, the pain completely disappeared. During the Glycopirrolate cream therapy, there were no side effects. This is a first report to document that a topical Glycopirrolate cream has a beneficial effect in a patient with hyperhidrosis and herpetic neuralgia.
Adjuvants, Anesthesia/administration & dosage/*therapeutic use ; Administration, Topical ; Adult ; Female ; Glycopyrrolate/administration & dosage/*therapeutic use ; Herpes Zoster/*drug therapy/pathology ; Humans ; Neuralgia/pathology/*physiopathology ; Pregnancy

The purpose of this prospective study was to evaluate the patient response and the changes of blood pressure and heart rate following intravenous administration of various dosage of fentanyl during awake fiberoptic nasotracheal intubation. After verbal informed consent, the 44 ASA status I or II patients undergoing oral and maxillofacial surgery were randomly assigned to receive 0(N=11), 1(N=11), 2(N=11), 3(N=l1) ug/kg of fentanyl, On arrival to operating room, midazolam 2 mg and glycopyrrolate 0.2 mg were administered for premedication. And then, EKG, blood pressure and peripheral O2 saturation were monitored continuously. Local anesthesia was induced with the gargling of 4% lidocaine 10ml, the transtracheal injection of 4% lidocaine 3ml and nasal spray 10% lidocaine 0.5ml. After that each dose of fentanyl was given to each groups. And then fiberoptic intubation was performed with continuous verbal contact to confirm the patient response and ventilatory status during intubation. During fiberoptic intubation, the peak level of blood pressure and heart rate were recorded. We compare the difference of blood pressure and heart rate between the value of just before fiberoptic intubation and the peak value during fiberoptic intubation and discomfort score according to fentanyl dosage on the first day of postoperation. The change of blood pressure and the time required for intubation was less and shortest in the 2 ug/kg of fentanyl group. But there were no significant differences in heart rate and discomfort score. We conclude that 2 ug/kg of fentanyl minimize the change of blood pressure as well as intubation time. But the change of dosage of fentanyl was not helpful to decrease the discomfort score.
Administration, Intravenous ; Anesthesia, Local ; Blood Pressure* ; Electrocardiography ; Fentanyl* ; Glycopyrrolate ; Heart Rate* ; Heart* ; Humans ; Informed Consent ; Intubation* ; Lidocaine ; Midazolam ; Operating Rooms ; Premedication ; Prospective Studies ; Surgery, Oral

In recent years, there has been renewed interest in preoperative methods to reduce gastric acidity, thus lessening the risk of a serious pulmonary reactions following aspiration of gastric contents. Emergency obstetrical patients frequently have large volumes of gastric fluid. It is less commonly appreciated that patients fasting prior to elective surgery afterive in operating room with large gastric fluid volumes with a low pH. Prophylactic preoperative oral administration of antacids has been shown to reduce preoperative gastric acidity in significant percentage of patients, but aspiration of antacids can be associated with pulmonary complications, and there use may be associated with increased gastric volume. Preoperative adrpinistration of glycopyrrolate may decrease the frequency of surgical patients with a low gastric pH, and it appears that the volume of gastric fluid may be reduced by medication that relax the pylorus. However, none of these pharmacologic manuevers completely abolisbes the possibility of serious pulmonary damage with aspiration. Mendelson and Teabeat demonstrated the importance of pH in the etiology of acid aspiration and it is generally accepted that the critical pH is 2. 5 or less, i.e. the risk of aerious pulmonary reaction increases progressively as the pH of the aspirate falls below 2.5. A critical volume of acid aspirate is also necessary for widespread pulmonary damage to occur irrespective of a low gastric pH. The critical volume is rhesus monkeys has been shown to be 0.4 ml/kg, but the critical volume in man is less well difined. Several investigators have determined the patient to be at risk of serious pulmonary complications with aspiration if at least 25 ml of gastric fluid with a pH of 2.5 or less is aspirated. The present study was undertaken to investigate the effects on the volume and pH of gastric juice under general anesthesia. The 35 patients were studied, and were divided. into 4 group account to the kind of premedicants, N.P.O. time, weight, and obstetric patients Gastric juice, aspirated through a Levine tube, was examined for pH and. volume under general anesthesia.
Accidental Falls ; Administration, Oral ; Anesthesia, General* ; Antacids ; Emergencies ; Fasting ; Gastric Acid ; Gastric Juice ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration* ; Macaca mulatta ; Operating Rooms ; Pylorus ; Research Personnel