BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Humans ; Muscle Rigidity ; Piperidines ; Plasma

BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Humans ; Muscle Rigidity ; Piperidines ; Plasma

Opioid-induced rigidity is a potentially life-threatening complication that can occur after treatment with large doses of opioids, but with early recognition it can be treated effectively with naloxone or with muscle relaxants. Regarding its onset time, there have been few case reports that have described delayed manifestations of opioid-induced rigidity. The mechanism of this complication is not well understood. In this report we describe a case of incidental overdose injection of sufentanil and subsequently review the confusing clinical features that require immediate diffenrentiation and the possible mechanim of this complication.
Analgesics, Opioid ; Muscle Rigidity ; Muscles ; Naloxone ; Sufentanil

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

Severe muscular rigidity is a rare but potentially serious side effect from the use of opioid, usually in high dose. However it has also been reported with the use of low to moderate dose of opioids in a few occasions. The age of the patients varied from newborn to old. These diverse and unpredictable natures of clinical manifestations seem to be related to the unknown mechanisms in the subcortical areas which are difficult to study. Now the author reports the case of severe muscular rigidity which occurred in the 5 year old child who received the usual analgesic dose of meperidine, notably in rapid injection. And after reviewing the related literatures,the author puts some emphasis regarding management of this problem.
Analgesics, Opioid ; Child ; Humans ; Infant, Newborn ; Meperidine ; Muscle Rigidity

Authors had reviewed the results of 20 anterior cervical fusions performed between 1975 and 1980 to determine which factors were important to a successful result. There had been 18 single level fusions and 2 fusions at two levels, the majority at C and C. The indications for fusion operation were: firstly in acutely traumatized patient was the spine representing radiologically the signs of segmental instability, secondly was the chronic segmental instability in old traumatized spine representing the nuchal rigidity and severe cervicobrachial pain which. was not ceased by conservative treatments. The index of successful fusion was complete relief of pain, loss of cervical rigidity and radiologlcal stability of fused segment indicated by no-movement in flexion-extension lateral radiograms, and the bony bridges between the fused segments. The postoperative stability of spine was assessed by measuring the changes of disc space and kyphotic angle. The result obtained were as follows: 1. Pre-and post-operative immobilization with cervical traction played an immportant role for successful results after fusion: 4–6 weeks of pre-operative traction in acutely injured spine provided the torn soft tissue structures with sufficient time needed for its healing, and 6 weeks of postoperative traction also provided the bone graft with sufficient time needed for its cooperation with graft bed. 2. ln all cases succeasful fusion was obtained. In a case a adjacent level was incorrectly fused, but it was fused soundly in time, while the unstable unfused segment was not fused spontaneously. 3. The fused segment or segments of spine stabilized clinically in 6-8 weeks after fusion operation which was proven by serial radiograms, and solid bony fusion was obtained radiologically averaging in 12 weeks after fusion operation. 4. The average increase of kyphosis after interbody fusion till solid fusion was negligible, averaging 3.0 degrees. 5. The solid fusion occurred in one to 2 weeks earlier in the spines with wedge and axial conpression fractures than the spines with flexion-rotation and shear types of fractures. 6. No further neurogical damage developed after successful fusion.
Dislocations ; Humans ; Immobilization ; Kyphosis ; Muscle Rigidity ; Spine ; Traction ; Transplants

Saccular aneurysms of the distal anterior cerebral artery are relatively rare, ranging from 1.5 to 9.2% of all intracranial aneurysms. A 61-year old woman presented with headache and nuchal rigidity. Cerebral angiographic image demonstrated multiple aneurysms of the distal anterior cerebral artery. We report a case of multiple aneurysms of the distal anterior cerebral artery without other vascular anomalies.
Aneurysm* ; Anterior Cerebral Artery* ; Female ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Muscle Rigidity

OBJECTIVES: This prospective study was designed to investigate the effect of serotonergic atypical antipsychotics on serum creatine phosphokinase. METHOD: The subjects were 60 inpatients who were medicated risperidone and nemonapride, atypical antipsychotics. The symptoms of NMS such as fever and muscle rigidity and the level of CRK of all subjects were assessed on the 5th, 10th, 20th, and 30th medication day. RESULTS: Sociodemographic variables, such as sex and mean age and number of intramuscular injection were not different between the risperidone and the nemonapride group. Maximum dosage of antipsychotics (chlorpromazine equivalent) was significantly higher in the nemonapride group. Fever and muscle rigidity were not different between two groups (p>0.05). The change of serum creatine phosphokinase was significantly higher in the risperidone group than the nemonapride group (p<0.05). CONCLUSIONS: Serum CRK showed a significant increase in risperidone than nemonapride group. Such a finding is primarily caused by the effect of atypical antipsychotics mediating serotonergic effects. It is not recommanded to stop the medication by misunderstanding the effect as a prodrome symptom of NMS.
Antipsychotic Agents* ; Creatine Kinase* ; Creatine* ; Fever ; Humans ; Injections, Intramuscular ; Inpatients ; Muscle Rigidity ; Negotiating ; Prospective Studies ; Risperidone*

In the unconscious patient with general muscle rigidity, the natural teeth can be luxated and then bite wounds may be occurred around lip, owing to the pathologic involuntary self-biting habit. If the forceful biting is generated continuously, the teeth may be avulsed and aspirated into the aerodigestive tract with the infection of biting wound. For the prevention of pulmonary aspiration of the teeth and wound infection, the biting teeth should be cared before the fact. The authors treated the teeth as endodontic drainage with removal of the crown or iodoform gauze drainage into the socket with extraction of the teeth. The prognosis was more favorable without biting wounds.
Crowns ; Dental Pulp Cavity* ; Drainage* ; Humans ; Lip ; Muscle Rigidity ; Prognosis ; Tooth ; Wound Infection ; Wounds and Injuries*

The neuroleptic malignant syndrome(NMS) results primarily from an imbalance of central neurotransmitters and typically occurs after acute or chronic neuroleptic drug use rather than after neuroleptic overdosage. It is a rare and serious iatrogenic syndrome that is characterized by hyperthermia, muscle rigidity, autonomic dysfunctions and altered mental status. We have observed a case of NMS-like state due to depot of chlorpromazine(CPZ) and have experienced symptomatic and supportive treatment, which including body surface cooling, fluid administration, diuretics, and diazepam. So, in order to provide interests with this clinical situation for emergency physician, pathophysiology is discussed with references to the possibility of NMS in our case and symptomatology and managements are also reviewed.
Chlorpromazine* ; Diazepam ; Diuretics ; Emergencies ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome ; Neurotransmitter Agents