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Scientific article
Case report
English

Naloxone-responsive acute dystonia and parkinsonism following general anaesthesia

Contributors

Iselin-Chaves, Irène Anne; Grotzsch, H.; Besson, Marie; Burkhard, Pierre; Savoldelli, Georges Louis

Published in

Anaesthesia, vol. 64, no. 12, p. 1359-1362

Publication date

2009

Abstract

Various movement disorders such as dystonia may acutely develop during or at emergence from general anaesthesia in patients with or without pre-existing Parkinson disease. These movements are triggered by a variety of drugs including propofol, sevoflurane, anti-emetics, antipsychotics and opioids. The postulated mechanism involves an imbalance between dopaminergic and cholinergic neurotransmitters in the basal ganglia. We report an acute, severe and generalised dystonic reaction in an otherwise healthy woman at emergence from general anaesthesia, dramatically reversed by the administration of naloxone, pointing to a potential role of the fentanyl and morphine that the patient had received. Recent literature on the mechanisms of abnormal movements induced by opioids are discussed. The severity of the reaction with usual doses of opioids, in a patient with no prior history of parkinsonism, led to further investigation that demonstrated the possibility of an enhanced susceptibility to opioids, involving a genetically determined abnormal function of glycoproteine-P and catechol-O-methyltransferase.

Keywords

  • Acute Disease
  • Adult
  • Anesthesia, General/adverse effects
  • Female
  • Humans
  • Naloxone/therapeutic use
  • Narcotic Antagonists/therapeutic use
  • Anesthesia, General / adverse effects
  • Dystonic Disorders / chemically induced
  • Dystonic Disorders / drug therapy
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Parkinsonian Disorders / chemically induced
  • Parkinsonian Disorders / drug therapy
  • Postoperative Complications / chemically induced
  • Postoperative Complications / drug therapy

UNIGE affiliation entities

UNIGE research groups

Citation (ISO format)

ISELIN-CHAVES, Irène Anne et al. Naloxone-responsive acute dystonia and parkinsonism following general anaesthesia. In: Anaesthesia, 2009, vol. 64, n° 12, p. 1359–1362. doi: 10.1111/j.1365-2044.2009.06068.x

Main files (1)

Article (Published version)

Identifiers

Journal ISSN

0003-2409
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Technical informations

Creation

23/04/2012 13:23:51

First validation

23/04/2012 13:23:51

Update

03/11/2026 15:13:44

Status update

03/11/2026 15:13:44

Last indexation

03/11/2026 15:13:45
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