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MOMENTARY DEATH AND CHOREOATHETOSIS FOLLOWING NITROUS OXIDE ANESTHESIA WITH RECOVERY

MOMENTARY DEATH AND CHOREOATHETOSIS FOLLOWING NITROUS OXIDE ANESTHESIA WITH RECOVERY Abstract Many reports1 have recently appeared describing damage to the brain following the use of nitrous oxide anesthesia, the pathologic changes being found predominantly in the cerebral cortex and the basal ganglia. Most of the patients die during the anesthesia or a short time thereafter. Sudden death, coma, convulsions, decerebrate phenomena, delirium, paralysis, hyperthermia, visual defects, aphasias and amnesia and mental and psychic changes have been reported in various combinations, with partial or complete recovery. The appearance of a clearcut clinical picture of extrapyramidal disease characterized mainly by choreoathetosis is rare. In 1887 Savage2 cited a case of delirium in which "irregular movements of all kinds were being made." The patient finally became demented and was placed in an institution, where she remained "silly and fat." In only 1 of Caine's3 4 cases, reported in 1923, did choreoathetoid movements develop as part of a residual picture, accompanied by References 1. Courville, C. B.: Asphyxia as a Consequence of Nitrous Oxide Anesthesia , Medicine 15:129-245 ( (May) ) 1936. 2. Löwenberg, K.; Waggoner, R., and Zbinden, T.: Destruction of Cerebral Cortex Following Nitrous Oxide-Oxygen Anesthesia , Ann. Surg. 104:801-810 ( (Nov.) ) 1936.Crossref 3. Löwenberg, K., and Zbinden, T.: Destruction of Cerebral Cortex Following Nitrous Oxide-Oxygen Anesthesia , Anesth. & Analg. 17:101-108 ( (March-April) ) 1938. 4. Abbott, C. N., and Courville, C. B.: Degeneration of Globus Pallidus After Anesthesia: Case with Survival Period of Forty-Two Days , Bull. Los Angeles Neurol. Soc. 3:46-50 ( (March) ) 1938. 5. Courville, C. B.: Pathogenesis of Necrosis of Cerebral Gray Matter Following Anesthesia , Ann. Surg. 107:371-379 ( (March) ) 1938. 6. O'Brien, J. D., and Steegmann, A. T.: Severe Degeneration of Brain Following Nitrous Oxide-Oxygen Anesthesia , Ann. Surg. 107:486-491 ( (April) ) 1938. 7. Savage, G. H.: Insanity Following the Use of Anesthetics in Operations , Brit. M. J. 2:1199 ( (Dec. 3) ) 1887. 8. Caine, A. M.: Some Unusual Complications of Nitrous Oxide-Oxygen Anesthesia , Am. J. Surg. (supp.) 37:34-36 ( (April) ) 1923. 9. Yaskin, J. C.: Nonsuppurative Nonepidemic Encephalitis Following Labor and in the Puerperium , Arch. Neurol. & Psychiat. 26:371-391 ( (Aug.) ) 1931. 10. Courville, C. B.: Lenticular Syndrome Following Nitrous Oxide Narcosis , Bull. Los Angeles Neurol. Soc. 1:30 ( (March) ) 1936. 11. Stewart, J. D.: Cerebral Asphyxia During Nitrous Oxide and Oxygen Anesthesia , New England J. Med. 218:754-757 ( (May 5) ) 1938. 12. Leake, C. D., and Hertzman, A. B.: Blood Reaction in Ethylene and Nitrous Oxide Anesthesia , J. A. M. A. 82:1162-1165 ( (April 12) ) 1924. 13. Greene, C. W., and Currey, H. M.: The Respiratory Gas Percentages During Anesthesia in Dogs , Arch. Int. Med. 35:371-379 ( (March) ) 1925. 14. Macklin, A. H.: The Asphyxial Element in Gas-Oxygen Anesthesia , Lancet 2:879-901 ( (Oct. 24) ) 1931. 15. Brown, W. E.; Lucas, G. H. W., and Henderson, V. E.: The Anesthetic Value of Nitrous Oxide Under Pressure , J. Pharmacol. & Exper. Therap. 31:269-289 ( (Aug.) ) 1927. 16. Murphy, F. J.: Anesthesia and Anoxemia in Relation to the Use of Nitrous Oxide , Surg., Gynec. & Obst. 70:741-743 ( (April) ) 1940. 17. Downs, T. M.: Carotid Sinus as an Etiological Factor in Sudden Anesthetic Death , Ann. Surg. 99:974-984 ( (June) ) 1934. 18. Löwenberg, Waggoner and Zbinden.1b 19. Löwenberg and Zbinden.1c 20. Notkin, J., and Savitsky, N.: Case of Illuminating Gas Poisoning with a Number of Neuropsychiatric Sequelae, the Main Being Peripheral Neuritis and Parkinsonism , J. Nerv. & Ment. Dis. 74:293-296 ( (Sept.) ) 1931. 21. Mackay, R. P.: Neurologic Findings Following Carbon Monoxide Poisoning: Report of a Case , J. A. M. A. 94:1733-1736 ( (May 31) ) 1930. 22. Gildea, E. F., and Cobb, S.: The Effects of Anemia on the Cerebral Cortex of the Cat , Arch. Neurol. & Psychiat. 23:876-903 ( (May) ) 1930. 23. Levine, A., and Schilder, P.: Motor Phenomena During Nitrogen Inhalation , Arch. Neurol. & Psychiat. 44:1009-1017 ( (Nov.) ) 1940. 24. Barcroft, J.: Anoxemia , Lancet 2:485-489 ( (Sept. 4) ) 1920. 25. Ford, F. R.; Walsh, F. B., and Jarvis, J. A.: Case of Extensive Injury to Cerebral Cortex Following Nitrous Oxide-Ether Anesthesia , Bull. Johns Hopkins Hosp. 61:246-257 ( (Oct.) ) 1937. 26. Baldwin, J. F.: Nitrous Oxide-Oxygen, the Most Dangerous Anesthetic , M. Rec. 90:177 ( (July 29) ) 1916. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology & Psychiatry American Medical Association

MOMENTARY DEATH AND CHOREOATHETOSIS FOLLOWING NITROUS OXIDE ANESTHESIA WITH RECOVERY

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Publisher
American Medical Association
Copyright
Copyright © 1942 American Medical Association. All Rights Reserved.
ISSN
0096-6754
DOI
10.1001/archneurpsyc.1942.02290020061005
Publisher site
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Abstract

Abstract Many reports1 have recently appeared describing damage to the brain following the use of nitrous oxide anesthesia, the pathologic changes being found predominantly in the cerebral cortex and the basal ganglia. Most of the patients die during the anesthesia or a short time thereafter. Sudden death, coma, convulsions, decerebrate phenomena, delirium, paralysis, hyperthermia, visual defects, aphasias and amnesia and mental and psychic changes have been reported in various combinations, with partial or complete recovery. The appearance of a clearcut clinical picture of extrapyramidal disease characterized mainly by choreoathetosis is rare. In 1887 Savage2 cited a case of delirium in which "irregular movements of all kinds were being made." The patient finally became demented and was placed in an institution, where she remained "silly and fat." In only 1 of Caine's3 4 cases, reported in 1923, did choreoathetoid movements develop as part of a residual picture, accompanied by References 1. Courville, C. B.: Asphyxia as a Consequence of Nitrous Oxide Anesthesia , Medicine 15:129-245 ( (May) ) 1936. 2. Löwenberg, K.; Waggoner, R., and Zbinden, T.: Destruction of Cerebral Cortex Following Nitrous Oxide-Oxygen Anesthesia , Ann. Surg. 104:801-810 ( (Nov.) ) 1936.Crossref 3. Löwenberg, K., and Zbinden, T.: Destruction of Cerebral Cortex Following Nitrous Oxide-Oxygen Anesthesia , Anesth. & Analg. 17:101-108 ( (March-April) ) 1938. 4. Abbott, C. N., and Courville, C. B.: Degeneration of Globus Pallidus After Anesthesia: Case with Survival Period of Forty-Two Days , Bull. Los Angeles Neurol. Soc. 3:46-50 ( (March) ) 1938. 5. Courville, C. B.: Pathogenesis of Necrosis of Cerebral Gray Matter Following Anesthesia , Ann. Surg. 107:371-379 ( (March) ) 1938. 6. O'Brien, J. D., and Steegmann, A. T.: Severe Degeneration of Brain Following Nitrous Oxide-Oxygen Anesthesia , Ann. Surg. 107:486-491 ( (April) ) 1938. 7. Savage, G. H.: Insanity Following the Use of Anesthetics in Operations , Brit. M. J. 2:1199 ( (Dec. 3) ) 1887. 8. Caine, A. M.: Some Unusual Complications of Nitrous Oxide-Oxygen Anesthesia , Am. J. Surg. (supp.) 37:34-36 ( (April) ) 1923. 9. Yaskin, J. C.: Nonsuppurative Nonepidemic Encephalitis Following Labor and in the Puerperium , Arch. Neurol. & Psychiat. 26:371-391 ( (Aug.) ) 1931. 10. Courville, C. B.: Lenticular Syndrome Following Nitrous Oxide Narcosis , Bull. Los Angeles Neurol. Soc. 1:30 ( (March) ) 1936. 11. Stewart, J. D.: Cerebral Asphyxia During Nitrous Oxide and Oxygen Anesthesia , New England J. Med. 218:754-757 ( (May 5) ) 1938. 12. Leake, C. D., and Hertzman, A. B.: Blood Reaction in Ethylene and Nitrous Oxide Anesthesia , J. A. M. A. 82:1162-1165 ( (April 12) ) 1924. 13. Greene, C. W., and Currey, H. M.: The Respiratory Gas Percentages During Anesthesia in Dogs , Arch. Int. Med. 35:371-379 ( (March) ) 1925. 14. Macklin, A. H.: The Asphyxial Element in Gas-Oxygen Anesthesia , Lancet 2:879-901 ( (Oct. 24) ) 1931. 15. Brown, W. E.; Lucas, G. H. W., and Henderson, V. E.: The Anesthetic Value of Nitrous Oxide Under Pressure , J. Pharmacol. & Exper. Therap. 31:269-289 ( (Aug.) ) 1927. 16. Murphy, F. J.: Anesthesia and Anoxemia in Relation to the Use of Nitrous Oxide , Surg., Gynec. & Obst. 70:741-743 ( (April) ) 1940. 17. Downs, T. M.: Carotid Sinus as an Etiological Factor in Sudden Anesthetic Death , Ann. Surg. 99:974-984 ( (June) ) 1934. 18. Löwenberg, Waggoner and Zbinden.1b 19. Löwenberg and Zbinden.1c 20. Notkin, J., and Savitsky, N.: Case of Illuminating Gas Poisoning with a Number of Neuropsychiatric Sequelae, the Main Being Peripheral Neuritis and Parkinsonism , J. Nerv. & Ment. Dis. 74:293-296 ( (Sept.) ) 1931. 21. Mackay, R. P.: Neurologic Findings Following Carbon Monoxide Poisoning: Report of a Case , J. A. M. A. 94:1733-1736 ( (May 31) ) 1930. 22. Gildea, E. F., and Cobb, S.: The Effects of Anemia on the Cerebral Cortex of the Cat , Arch. Neurol. & Psychiat. 23:876-903 ( (May) ) 1930. 23. Levine, A., and Schilder, P.: Motor Phenomena During Nitrogen Inhalation , Arch. Neurol. & Psychiat. 44:1009-1017 ( (Nov.) ) 1940. 24. Barcroft, J.: Anoxemia , Lancet 2:485-489 ( (Sept. 4) ) 1920. 25. Ford, F. R.; Walsh, F. B., and Jarvis, J. A.: Case of Extensive Injury to Cerebral Cortex Following Nitrous Oxide-Ether Anesthesia , Bull. Johns Hopkins Hosp. 61:246-257 ( (Oct.) ) 1937. 26. Baldwin, J. F.: Nitrous Oxide-Oxygen, the Most Dangerous Anesthetic , M. Rec. 90:177 ( (July 29) ) 1916.

Journal

Archives of Neurology & PsychiatryAmerican Medical Association

Published: Feb 1, 1942

References