Background: Systemic absorption of topical phenylephrine administered during mydriasis may potentially cause hemodynamic changes in patients. Objective: To compare the hemodynamic outcomes between patients given tropicamide+phenylephrine and those given tropicamide alone for mydriasis. Design: Randomized controlled trial. Setting: Ophthalmology Outpatient Clinic, Southern Philippines Medical Center, Davao City, from April to June 2017. Participants: 56 male and female patients aged ≥ 19 years and scheduled for mydriasis. Interventions: Random allocation to either one drop of 0.5% tropicamide plus 0.5% phenylephrine or one drop of 0.5% tropicamide for mydriasis of the examined eye. Main outcome measures: Mean systolic BP, mean diastolic BP, mean arterial pressure, mean heart rate, and at least one episode of tachycardia or bradycardia. Main results: Thirty (53.57%) patients received tropicamide drops, and the rest received tropicamide+phenylephrine drops. The demographic and clinical characteristics of the two intervention groups were comparable at baseline. The mean blood pressures and heart rates at 15, 30, 45, and 60 minutes postmydriasis did not significantly differ between the two groups. Four patients from the tropicamide group, and none from the phenylephrine+tropicamide group had tachycardia (p=0.1153). On the other hand, five patients from the tropicamide group, and four from the phenylephrine+tropicamide group had bradycardia (p=1.0000). Conclusion Hemodynamic outcomes did not significantly differ up to 60 minutes after mydriasis between patients who received tropicamide+phenylephrine drops and those who received tropicamide drops.
Blood Pressure ; Heart Rate ; Sympathomimetics ; Muscarinic Antagonists ; Parasympatholytics

Pylorospasm is a cause of delayed gastric emptying in young infants. As in patients with hypertrophic pyloric stenosis, most pylorospasm patients present with projectile vomiting. However, unlike that in case of hypertrophic pyloric stenosis, no persistent pyloric stenotic lesions are present. As such, follow-up using serial gastrointestinal fluoroscopy or ultrasonography can be helpful in diagnosing patients with clinical signs of gastroparesis. Most cases can be treated conservatively, but some patients require pharmacologic treatment. Antispasmodics have been proposed as a treatment for pylorospasm, but their use in neonates and infants has rarely been reported. Herein, we present a case of pylorospasm diagnosed in the neonatal period and successfully treated with intravenous atropine.
Atropine ; Fluoroscopy ; Follow-Up Studies ; Gastric Emptying ; Gastroparesis ; Humans ; Infant ; Infant, Newborn ; Parasympatholytics ; Pyloric Stenosis, Hypertrophic ; Pylorus ; Spasm ; Ultrasonography ; Vomiting

Chemodenervation with botulinum toxin (BTX) has been recommended for focal spasticity. BTX injection should be performed with caution in patients with bleeding disorders and/or receiving anticoagulation therapy. We present a case of BTX injection for post-stroke spasticity in a patient with hemophilia A who could not take oral spasmolytics due to chronic hepatitis C. To minimize the bleeding risk, we replaced factor VIII intravenously in accordance with the World Federation of Hemophilia guidelines for minor surgery. FVIII (3,000 IU) was administered 15 minutes before BTX injection. One day later, 2,000 IU was administered, and 2 days later, another 2,000 IU was administered. We performed the real-time Ultrasound-guided BTX injection three times, then spasticity and upper extremity function improved without adverse events. BTX injection can be considered as a treatment option for spasticity among patients with hemophilia.
Botulinum Toxins* ; Factor VIII* ; Hemophilia A* ; Hemorrhage ; Hepatitis C, Chronic ; Humans ; Minor Surgical Procedures ; Muscle Spasticity* ; Nerve Block ; Parasympatholytics ; Stroke* ; Ultrasonography ; Upper Extremity

Antispasmodics are effective in reducing abdominal pain and controlling spasm. Irritable bowel syndrome (IBS) patients have characteristic key factors such as intestinal motility disorder and visceral hypersensitivity. So antispasmodics have been used in the treatment of IBS for decades. Mebeverine blocks intestinal peristalsis but are not significantly better than placebo. Alverine citrate combined with simethicone is effective treatment option in IBS. Otilonium and pinaverium bromide are poorly absorbed agents, so they have mostly local effect with minimal systemic adverse events. Phloroglucinol controls acute exacerbation of abdominal pain effectively. Tiropramide reduce abdominal discomfort without serious adverse events. Fenoverine control spasm in spastic colon but does not affect normal contraction. Trimebutine have dual actions that it inhibits hyperactive colon and activates hypomotile colon. Each drug has advantages and disadvantages. Antispasmodics are considered as the first treatment option of pain-dominant IBS.
Abdominal Pain ; Citric Acid ; Colon ; Gastrointestinal Motility ; Humans ; Hypersensitivity ; Irritable Bowel Syndrome ; Muscle Spasticity ; Parasympatholytics ; Peristalsis ; Phloroglucinol ; Simethicone ; Spasm ; Trimebutine

Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.
Abdominal Pain ; Anti-Bacterial Agents ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bile ; Chloride Channel Agonists ; Constipation ; Diarrhea ; Dietary Fiber ; Drug Therapy* ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome* ; Laxatives ; Muscle, Smooth ; Parasympatholytics ; Probiotics ; Quality of Life ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin 5-HT4 Receptor Agonists ; Serotonin Uptake Inhibitors

Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.
Abdominal Pain ; Anti-Bacterial Agents ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bile ; Chloride Channel Agonists ; Constipation ; Diarrhea ; Dietary Fiber ; Drug Therapy* ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome* ; Laxatives ; Muscle, Smooth ; Parasympatholytics ; Probiotics ; Quality of Life ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin 5-HT4 Receptor Agonists ; Serotonin Uptake Inhibitors

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning* ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

BACKGROUND/AIMS: Suppression of gastrointestinal (GI) peristalsis during GI endoscopy commonly requires antispasmodic agents such as hyoscine butylbromide, atropine, glucagon, and cimetropium bromide. This study examined the efficacy of oral phloroglucin for the suppression of peristalsis, its impact on patient compliance, and any associated complications, and compared it with intravenous or intramuscular cimetropium bromide administration. METHODS: This was a randomized, investigator-blind, prospective comparative study. A total of 172 patients were randomized into two groups according to the following medications administered prior to upper endoscopy: oral phloroglucin (group A, n=86), and cimetropium bromide (group B, n=86). The numbers and the degrees of peristalsis events at the antrum and second duodenal portion were assessed for 30 seconds. RESULTS: A significantly higher number of gastric peristalsis events was observed in group A (0.49 vs. 0.08, p<0.001), but the difference was not clinically significant. No significant difference between both groups was found in the occurrence of duodenal peristalsis events (1.79 vs. 1.63, p=0.569). The incidence of dry mouth was significantly higher with cimetropium bromide than with phloroglucin (50% vs. 15.1%, p<0.001). CONCLUSIONS: Oral phloroglucin can be used as an antispasmodic agent during upper endoscopy, and shows antispasmodic efficacy and adverse effects similar to those of cimetropium bromide.
Atropine ; Endoscopy ; Endoscopy, Digestive System* ; Glucagon ; Humans ; Incidence ; Mouth ; Parasympatholytics ; Patient Compliance ; Peristalsis ; Premedication* ; Prospective Studies ; Scopolamine Hydrobromide

OBJECTIVETo investigate the impact of intestinal spasmolytic on colon polyps and adenoma detection rate during colonoscopy.

METHODSLiteratures related to the effect of intestinal spasmolytic on colon polyp or adenoma detection rate were retrieved from PubMed, Medline, EBSCO, High Wire Press, OVID, EMBASE, and the China National Knowledge Articles, etc. published before July 2014. Unified data were extracted by two researchers independently and organized using Jadad scale to evaluate the quality of the enrolled studies through Review manager 5.2 Meta-analysis software.

RESULTSSix articles were enrolled with total 47,509 cases, including 16,867 cases in the scopolamine group and 30,642 cases in the placebo group. Meta analysis showed spasmolytic could increase the detective rate of polyps (OR=1.24, 95% CI:1.19-1.30), adenoma (OR=1.25, 95% CI:1.19-1.30) and high-risk adenoma (OR=1.22, 95% CI:1.16-1.29).

CONCLUSIONUsing colonoscopy spasmolytic scopolamine can increase the detection rate of colonic polyp and adenoma.