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Edinoff AN, Armistead G, Rosa CA, Anderson A, Patil R, Cornett EM, Murnane KS, Kaye AM, Kaye AD. Phenothiazines and their Evolving Roles in Clinical Practice: A Narrative Review. Health Psychol Res 2022; 10:38930. [PMID: 36425230 PMCID: PMC9680852 DOI: 10.52965/001c.38930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Phenothiazines, a diverse class of drugs, can be used to treat multiple mental health and physical conditions. Phenothiazines have been used for decades to treat mental illnesses, including schizophrenia, mania in bipolar disorder, and psychosis. Additionally, these drugs offer relief for physical illnesses, including migraines, hiccups, nausea, and vomiting in both adults and children. Further research is needed to prove the efficacy of phenothiazines in treating physical symptoms. Phenothiazines are dopaminergic antagonists that inhibit D2 receptors with varying potency. High potency phenothiazines such as perphenazine are used to treat various psychiatric conditions such as the positive symptoms of schizophrenia, the symptoms of psychosis, and mania that can occur with bipolar disorder. Low/mid potency phenothiazines such as chlorpromazine antipsychotic drugs that have been used to treat schizophrenia and schizophrenia-like disorders since the 1950s and are utilized in numerous disease states. The present investigation aims to elucidate the effects of phenothiazines in clinical practice.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport
| | - Grace Armistead
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport
| | - Christina A Rosa
- Department of Psychology, University of California, Santa Barbara
| | | | - Ronan Patil
- School of Medicine, The George Washington University
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Kevin S Murnane
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Shreveport; Louisiana State University Health Shreveport, Department of Pharmacology, Toxicology & Neuroscience; Louisiana Addiction Research Center
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
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Tariq K, Das JM, Monaghan S, Miserocchi A, McEvoy A. A case report of Vagus nerve stimulation for intractable hiccups. Int J Surg Case Rep 2020; 78:219-222. [PMID: 33360634 PMCID: PMC7773651 DOI: 10.1016/j.ijscr.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
Intractable hiccups are associated with significant morbidity and may lead to mortality. Several medical, pharmacological, surgical and novel treatment options are available. Vagus nerve stimulator placement is a novel surgical option for the treatment of intractable hiccups. Vagus nerve stimulator is currently not approved for the indication of intractable hiccups.
Introduction Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. Presentation of the case An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. Discussion A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. Conclusion VNS insertion is a novel surgical option for the treatment of intractable hiccups.
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Affiliation(s)
- Kanza Tariq
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK.
| | - Joe M Das
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Sasha Monaghan
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Anna Miserocchi
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Andrew McEvoy
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
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Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review. J Emerg Med 2018; 53:540-549. [PMID: 29079070 DOI: 10.1016/j.jemermed.2017.05.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 05/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another. OBJECTIVE This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects. METHODS A systematic literature search of PubMed, Embase, the Cochrane Library, and the New York Academy of Medicine was performed to find articles where a pharmacologic agent was used to treat intractable or persistent hiccups between the years 1966 and 2016. The GRADE method was used to assess the level of evidence for the studies included in this review. RESULTS This review identified 26 articles involving 10 pharmacologic treatment options that met our inclusion criteria. Amitriptyline, baclofen, gabapentin, haloperidol, metoclopramide, midazolam, nifedipine, nimodipine, orphenadrine, and valproic acid were found in the literature to be successful in treating hiccups. CONCLUSION Baclofen, gabapentin, and metoclopramide were the only agents that were studied in a prospective manner, while only baclofen and metoclopramide were studied in randomized controlled trials. No specific recommendations can be made for treating intractable and persistent hiccups with the evidence currently available in the literature. Therapy selection should be specific to individual patients, their underlying comorbidities, etiology of hiccups, and take into account the individual properties of the drugs.
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Abstract
PURPOSE OF REVIEW Hiccups are a common problem that crosses multiple disciplines including neurology, gastroenterology and pulmonology, and primary care. There are no formal guidelines to the treatment of intractable hiccups and treatment is based on experience and anecdotal evidence often relying on older medications. We have reviewed the relevant literature with an emphasis on the last five years or so in management of intractable hiccups. RECENT FINDINGS The production of hiccups is a complex mechanism which involves multiple neurotransmitters and anatomical structure within the central and peripheral nervous system. A number of medications and other therapy have been reported successful for intractable hiccups. Intractable hiccups can occur more often than we realize and present to multiple medical disciplines. A number of pharmacologic option have been found to be useful including dopamine-blocking medication, baclofen, and gabapentin along with anticonvulsants.
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Prakash S, Sitalakshmi N. Management of intraoperative hiccups with intravenous promethazine. J Anaesthesiol Clin Pharmacol 2013; 29:561-2. [PMID: 24250003 PMCID: PMC3819860 DOI: 10.4103/0970-9185.119131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Smita Prakash
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Greenfield MA, Waldman S. Phrenic Nerve Block. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hackworth WA, Kimmelshue KN, Stravitz RT. Peritoneal sarcoidosis: a unique cause of ascites and intractable hiccups. Gastroenterol Hepatol (N Y) 2009; 5:859-861. [PMID: 20567531 PMCID: PMC2886385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- W. Andrew Hackworth
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Katherine N. Kimmelshue
- Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - R. Todd Stravitz
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Amirjamshidi A, Abbassioun K, Parsa K. Hiccup and neurosurgeons: a report of 4 rare dorsal medullary compressive pathologies and review of the literature. ACTA ACUST UNITED AC 2007; 67:395-402; discussion 402. [PMID: 17350413 DOI: 10.1016/j.surneu.2006.10.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to present 4 rare cases of medullary compressive lesions presenting with IH, to discuss the indications for neurosurgical decompression in such cases, and to review the possible etiologies of IH briefly. METHODS The reported cases include (1) a 19-year-old adolescent boy and a 21-year-old man with Chiari I malformation and cervical syrinx compressing or tightening the cervico-medullary junction; (2) a 35-year-old man with ependymoma extending from the lower half of the fourth ventricle to C1/C2 junction and compressing this part of the medulla; and (3) a 16-year-old adolescent boy who was referred to the emergency department in severe distress because of IH, occurring as a result of a distal PICA aneurysm located on the floor of the lower triangle of the fourth ventricle. RESULTS Surgical decompression in all the cases was successful in withholding the hiccups. CONCLUSION The dorsal medullary area is not an unusual location for genesis of hiccup. When encountering a case of IH, appropriate CNS imaging studies should be included in the evaluation protocol.
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Affiliation(s)
- Abbass Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 19585, Iran.
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Garrigues P, Giovansili B, Villard F, Coquery ML, Bellahouel S, Duc P, Champetier de Ribes D. [Renal cyst inducing hiccups]. Presse Med 2007; 36:239-42. [PMID: 17259033 DOI: 10.1016/j.lpm.2006.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 07/27/2006] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hiccups are a sudden, irregular and spasmodic contraction of the diaphragm followed by an abrupt closure of the glottis. Besides etiologic treatment, its management is above all symptomatic and based primary on medical treatment. CASE We report a case of chronic hiccups associated with an abscessed voluminous renal cyst. Drainage of the cyst resolved the hiccups. DISCUSSION Various symptomatic treatments failed because the hiccups were due to irritation of the phrenic nerve by an abscessed renal cyst. This case reminds us that an extensive etiologic work-up may be necessary when symptomatic treatment of hiccups is ineffective.
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Affiliation(s)
- Philippe Garrigues
- Service de médecine interne, Hôpital du Perpétuel Secours, Levallois-Perret (93).
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Greenfield MA. Phrenic Nerve Block. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
✓ Intractable hiccups are debilitating and usually a result of some underlying disease. Initial management includes vagal maneuvers and pharmacotherapy. When hiccups persist despite medical therapy, surgical intervention rarely is pursued. Cases described in the literature cite successful phrenic nerve blockade, crush injury, or percutaneous phrenic nerve pacing. The authors report on a case of intractable hiccups occurring after a posterior fossa stroke. Complete resolution of the spasms has been achieved to date following the placement of a vagus nerve stimulator.
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Affiliation(s)
- Bryan Rankin Payne
- Department of Neurosurgery, Louisiana State University Medical School, New Orleans, Louisiana 70112, USA.
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Shin CH, Seo SJ, Choi HG, Kim DS, Ryu SJ, Jang TH. Management of Intractable Hiccups -A report of 3 cases-. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.1.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chul Ho Shin
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Suk Joo Seo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University, Busan, Korea
| | - Hyung Gyu Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University, Busan, Korea
| | - Doo Sik Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University, Busan, Korea
| | - Sie Jeong Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University, Busan, Korea
| | - Tae Ho Jang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kosin University, Busan, Korea
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Slipman CW, Shin CH, Patel RK, Braverman DL, Lenrow DA, Ellen MI, Nematbakhsh MA. Persistent hiccup associated with thoracic epidural injection. Am J Phys Med Rehabil 2001; 80:618-21. [PMID: 11475484 DOI: 10.1097/00002060-200108000-00014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.
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Affiliation(s)
- C W Slipman
- Penn Spine Center, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Affiliation(s)
- V Vaidya
- Department of Psychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA
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Musumeci A, Cristofori L, Bricolo A. Persistent hiccup as presenting symptom in medulla oblongata cavernoma: a case report and review of the literature. Clin Neurol Neurosurg 2000; 102:13-7. [PMID: 10717396 DOI: 10.1016/s0303-8467(99)00058-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rare case of persistent intractable hiccup as presenting symptom of cavernous angioma in the medulla oblongata is reported. Pathophysiologic hypotheses about the triggering mechanism of hiccup are discussed, with special reference to the causes affecting the central nervous system. A review of the literature concerning medullary lesions presenting with persistent hiccup is also reported. Finally we have included some brief considerations about cavernous angiomas and the patterns of their clinical presentation, focusing on those located in the medulla oblongata.
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Affiliation(s)
- A Musumeci
- Department of Neurosurgery, University Hospital, Piazzale Stefani 1, 37126, Verona, Italy.
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Abstract
The efficacy of baclofen in the treatment of chronic hiccup is demonstrated in two cases. These cases highlight the present state of knowledge related to hiccup. This discussion focuses on the definition and classification of hiccup, etiologies, postulated theories to explain its function, the few studies performed to date, and non-pharmacologic and pharmacologic treatment. Baclofen appears to be the agent most efficacious in the treatment of chronic hiccup. Its commonest side effect is sedation; insomnia, dizziness, weakness, ataxia, and confusion also can occur. Following regular use, abrupt discontinuation can lead to withdrawal symptoms, such as seizure, and gradual discontinuation is recommended.
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Affiliation(s)
- P Walker
- Palliative Care Program, Grey Nuns Community Hospital and Health Center, Edmonton, Alberta, Canada
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Abstract
OBJECTIVE To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management. DESIGN Case series, retrospective chart review. SETTING Inpatient stroke rehabilitation floor within a tertiary care teaching hospital. PATIENTS Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases. INTERVENTIONS None. MAIN OUTCOME MEASURE Response to pharmacologic treatment. RESULTS All three subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Treatment with carbamazepine was successful in only one patient; in the other two subjects, their hiccups were controlled with haloperidol or baclofen. All subjects were ultimately managed with a single agent. CONCLUSIONS Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation patient. Intractable hiccups can be associated with potentially fatal consequences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding management of this challenging population.
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Affiliation(s)
- A Kumar
- Division of Rehabilitation, Washington University School of Medicine, St Louis, MO, USA
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Abstract
The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess of gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined. Numerous treatment modalities have been tried but with questionable success. Valproate has proven effective in two trials investigating persistent non-surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided.
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Affiliation(s)
- B J Hansen
- Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark
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20
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Johnson DL. Intractable hiccups: treatment by microvascular decompression of the vagus nerve. Case Report. J Neurosurg 1993; 78:813-6. [PMID: 8468612 DOI: 10.3171/jns.1993.78.5.0813] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Idiopathic hiccups are usually managed with pharyngeal stimulation or a plethora of pharmacological agents. Hiccups that persist and prove intractable to these medical measures are treated by crush or ablation of the phrenic nerve, which denervates the major respiratory muscle. This is the first reported case of nondestructive microvascular decompression of the vagus nerve for the treatment of intractable idiopathic hiccups. The success of microvascular decompression has been documented with other conditions, such as trigeminal neuralgia and hemifacial spasm, that are characterized by hyperactive dysfunctional neurovascular contact. The vagus nerve was separated from the posterior inferior cerebellar artery by inserting a Teflon pledget between the nerve and vessel which eliminated the neurovascular contact. One year after the initial surgery, the hiccups recurred. The Teflon pledget had fallen out of place and the nerve was once again in contact with the artery. Once the contact was eliminated by wrapping the artery with a tuft of Teflon, the hiccups stopped. The patient has remained free of hiccups for 3 years. It is concluded that patients with intractable idiopathic hiccups who fail medical therapy should be considered for microvascular decompression of the vagus nerve.
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Affiliation(s)
- D L Johnson
- Division of Neurosurgery, Children's Hospital, Penn State University School of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Abstract
Hiccup or singultus is a repeated involuntary, spasmodic contraction of the diaphragm accompanied by a sudden closure of the glottis mediated by sensory branches of the phrenic and vagus nerves as well as dorsal sympathetic afferents. The principle efferent limb and diaphragmatic spasms are mediated by motor fibers of the phrenic nerve. Hiccup has been classified as a respiratory reflex and the central connection probably consists an interaction among the brainstem respiratory centers, phrenic nerve nuclei, medullary reticular formation and the hypothalamus. Chronic intractable hiccup may be due to brainstem seizures, and baclofen may be the long-awaited remedy for intractable hiccup as demonstrated in three illustrative cases.
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Affiliation(s)
- H Fodstad
- Division of Neurosurgery, Beth Israel Medical Centre, New York
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Weksler N, Stav A, Ovadia L, Berman M, Segal A, Ribac L, Lemberg L. Lidocaine pretreatment effectively decreases the incidence of hiccups during methohexitone administration for dilatation and curettage. Acta Anaesthesiol Scand 1992; 36:772-4. [PMID: 1466212 DOI: 10.1111/j.1399-6576.1992.tb03562.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The efficacy of lidocaine 1 mg.kg-1 for prevention of methohexitone-induced hiccups was assessed in a double-blind fashion in 200 patients undergoing dilatation and curettage for pregnancy interruption. The patients were randomly assigned to receive either lidocaine 1% or saline 0.9% in a similar way (1 ml for every 10 kg of body weight). The incidence of hiccups was 16% in the control group compared to 6% in the lidocaine group. We speculate that this reduction in the methohexitone-induced hiccup ratio is related to lidocaine's membrane-stabilizing properties, which decrease the excitability of all the nervous structures involved in this reflex.
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Affiliation(s)
- N Weksler
- Department of Anaesthesia, Hillel Yaffe Medical Center, Hadera, Israel
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Abstract
Hiccups are a common, and fortunately usually transient, benign malady. Occasionally, however, hiccups fail to resolve spontaneously, resulting in patient fatigue and incapacitation and the need for the affected individual to seek medical care for resolution of the problem. The approach to the management of these patients consists of the identification and treatment of serious underlying causes of the episode as well as therapeutic interventions to achieve hiccup resolution.
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Affiliation(s)
- P W Kolodzik
- Department of Emergency Medicine, Wright State University School of Medicine, Dayton, Ohio 45401-0927
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25
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Abstract
A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.
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Affiliation(s)
- M Odeh
- Department of Inernal Medicine, Bnai Zion Medical Center, Haifa, Israel
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27
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Abstract
Chronic hiccups may be a problem of great significance to the affected patient. A 62-year-old man with severe heartburn and persistent hiccups despite numerous diagnostic tests and therapeutic drug trials presented to our clinic. Esophageal motility and intraluminal pH studies demonstrated decreases in intraesophageal pressure during hiccups and acid exposure during 68% of the measured time. The patient underwent Nissen fundoplication, which improved his heartburn but not his hiccups. The association between gastroesophageal reflux and hiccups is discussed. Our experience suggests that the presence of hiccups and gastroesophageal reflux in the same patient may be coincidental rather than having a cause-and-effect relationship.
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Affiliation(s)
- M J Fisher
- Department of Internal Medicine, University of Virginia, Charlottesville 22908
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29
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Abstract
In two patients, persistent hiccups were an unusual presenting manifestation of hyponatremia. Persistent hiccups occur in a variety of serious diseases, including metabolic and electrolyte disorders. They may cause the victim significant distress and may be refractory to most treatments. Hiccups lasting more than 24 hours require investigation for an underlying organic etiology, with hyponatremia included in the differential diagnosis.
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Abstract
Psychogenic polydipsia is an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink. The excessive water-drinking is well tolerated unless hyponatremia supervenes. This report describes 11 patients with psychogenic polydipsia and hyponatremia (ten men and one woman) who were collectively hospitalized a total of 70 times for treatment of complications of this disorder. This group differs from the classical patient with psychogenic polydipsia, ie, a hospitalized schizophrenic, in that none was institutionalized and there was a high incidence of chronic alcoholism (10), intractable hiccups (7), self-induced vomiting (6), and laboratory evidence for rhabdomyolysis (5).
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Abstract
Metoclopramide has wide applications in both clinical and experimental medicine. It is useful in the management of gastro-oesophageal reflux and gastric stasis. It is being used increasingly in the management of nausea and vomiting, and at high doses will significantly relieve the emesis that is induced by cytotoxic agents. Metoclopramide also has an important place in the investigation of the role of dopamine in physiological and pathological processes.
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Abstract
We present the case of a patient who presented with persistent hiccups induced by a hair irritating the tympanic membrane and activating the vagally mediated hiccup neural reflex arc. Commonly identified etiologies and treatments of this condition are then reviewed.
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Sohn YZ, Conrad LJ, Katz RL. Hiccup and ephedrine. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1978; 25:431-2. [PMID: 698875 DOI: 10.1007/bf03006576] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Twelve patients who developed hiccup during anaesthesia and surgery were treated successfully with an intravenous injection of ephedrine 5 mg (eleven cases) or 10 mg (one case). In nine patients ephedrine was successful after traditional methods had been tried and failed, and in three patients ephedrine was the only agent given. We conclude that ephedrine is a safe and easy mode of treatment for intractable hiccup during anaesthesia and surgery.
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