Fig 2 - available from: Journal of Medical Case Reports
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Clinical course after admission. Blood pressure gradually decreased in response to an increase in catecholamine administration. After initiating vasopressin, hypotension markedly improved. BP blood pressure, CHDF continuous hemodiafiltration, DBP diastolic blood pressure, DOA dopamine, DOB dobutamine, HR heart rate, NAD noradrenaline, SBP systemic blood pressure, VAS vasopressin
Source publication
Background
Catecholamine agents are commonly used to support circulation; however, they may cause unexpected hypotension in a special situation. Here we describe the first unexpected case of hypotension in response to catecholamine agents.
Case presentation
A 29-year-old Japanese man with schizophrenia was transferred to our emergency department....
Context in source publication
Context 1
... his shock and coma. Fluid resuscitation of 3000 ml crystalloid temporarily increased his BP to 73/28 mmHg, but his shock still persisted. Before a central venous line was inserted, we tentatively initiated dopamine infusion at 5 μg/kg per minute, which was increased to 10 μg/kg per minute; however, his hypotension gradually worsened to 66/37 mmHg (Fig. 2). Sixty minutes after arrival, we inserted the central venous line and initi- ated noradrenaline infusion at 0.1 μg/kg per minute, which was subsequently increased to 0.3 μg/kg per minute. Moreover, 90 minutes after arrival, we initi- ated dobutamine at 5 μg/kg per minute. However, his BP unexpectedly decreased to 59/40 mmHg. Head ...
Citations
... Catecholamine-induced hypotension following overdose has been observed with the use of psychotropic medications including quetiapine and risperidone. 3 These medications cause αantagonism. Catecholamine agents such as adrenaline also have β 2 -agonism which increases vasodilation. ...
... The case report by Okada et al. 3 recommended the use of vasopressin as rescue due to the overlapping effects of the α and βadrenergic receptors in most common inotropes and vasopressors. However, in this particular case, the use of noradrenaline resulted in a prompt and satisfactory increase in blood pressure to facilitate intubation. ...
In patients presenting with hypotension due to significant quetiapine or mixed overdose, adrenaline should be avoided and consider medications such as noradrenaline or vasopressin as an alternative. If using noradrenaline peripherally, use a lower concentration (4 mg in 50 mL 5% glucose) and use a large bore cannula in a large vein.
... Therefore, lidocaine containing adrenaline should be carefully administered in patients who are being treated with antipsychotics, such as patients with schizophrenia, autism, intellectual disability, and dementia. Okada et al. [6] reported a schizophrenic patient with risperidone overdose who experienced unexpected hypotension in response to noradrenaline infusion. They believe that this unexpected hypotension in response to catecholamine infusion was caused by the α-adrenergic blockade effect of risperidone. ...
Background: Local anesthetic containing adrenaline is commonly used in many operations to maintain hemostasis and prolong the duration of anesthesia. Antipsychotic drugs have an α-adrenergic receptor blocking action, and it is thought that β-adrenergic receptors predominate when adrenaline is administered in combination, thus inducing hypotension. Many general anesthetics have vasodilatory effects, and it is possible that blood pressure may decrease further if adrenaline-containing lidocaine is administered to antipsychotic users during anesthesia. This study aimed to assess the circulation dynamics in regular antipsychotics users administered adrenaline-containing lidocaine under general anesthesia in a dental procedure.
Methods: Participants included 30 patients regularly using antipsychotics (butyrophenone, phenothiazine, and/or atypical antipsychotics) who were scheduled for dental treatment to be performed under general anesthesia. At five minutes after tracheal intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and percutaneous oxygen saturation (SpO2) were measured as a baseline. SBP, DBP, HR, and SpO2 were measured 2, 4, 6, 8, and 10 minutes after the injection of 1.8 mL of 2% lidocaine (32 mg) with 1:80,000 adrenaline (22.5 μg) into the oral cavity. Differences in the SBP, DBP, HR, and SpO2 between baseline and at each time point were analyzed using Dunnett’s test.
Results: No significant changes were observed in the SBP, DBP, HR, and SpO2 compared to baseline until ten minutes after the administration of adrenaline-containing lidocaine. No adverse events were observed up to one hour after the administration of adrenaline-containing lidocaine.
Conclusions: This study demonstrated that adrenaline used at the usual dose for dental treatment under general anesthesia is unlikely to affect the circulation dynamics of regular antipsychotic users.
