Paradoxical reaction in ADHD
| Autor: | Markus Wittmann, Rüdiger Bär, Norbert Wodarz, Rainer Laufkötter, Berthold Langguth |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
business.industry
Paradoxical reaction Brain General Medicine Review Article Awareness medicine.disease Intraoperative Awareness Nicotine chemistry.chemical_compound Muscle relaxation chemistry Anesthesia Anesthetic medicine Attention deficit hyperactivity disorder Outpatient clinic Humans Local anesthesia Wakefulness Caffeine business medicine.drug |
| Zdroj: | Deutsches Arzteblatt international. 108(31-32) |
| ISSN: | 1866-0452 |
| Popis: | In our outpatient clinic for adults with attention deficit hyperactivity disorder (ADHD), 10–20% of those affected repeatedly complained about abnormally extended (24 hours) or (more often) notably shortened or reduced effectiveness of local anesthesia injections for dental treatment. Some patients reported paradoxical reactions to postoperative administration of tranquillizers (including benzodiazepines). These drugs made them “even more awake”, much to their doctor’s surprise. One female patient reported that she had followed the surgeons’ conversations during the initial 10 minutes of the operation under full anesthesia and complete muscle relaxation. The surgeons were surprised at the amount of details she remembered. In other patients, anesthetics worked for ”too long” or had “too strong an effect.” Many people with ADHD have next to no reaction or react paradoxically to caffeine (coffee/black tea/cola) and other stimulants (nicotine, “Red Bull,” amphetamines). One female patient also reported excessive awareness —and better cognition—when taking antihistamines (for example, “Fenistil” [dimethindene maleate]). Such “idiosyncratic” reactions seem to be stable over time, which means that the different effects are predictable. We therefore advise our ADHD patients to inform their anesthesiologist before an operation that they may react differently to caffeine, antihistamines/low-potency neuroleptics, benzodiazepines (and also central and peripheral anesthetic drugs). Many mentally healthy people also react in a primarily unexpected way to caffeine, etc. It therefore may make sense to ask patients preoperatively about untypical reactions to this (not very long) list of different substances, in order to anticipate possible intraoperative and postoperative problems and to avoid these where possible. Presumably such atypical reactions are genetically determined. Therefore “idiosyncrasies” in family members may as well provide a hint for an increased risk of abnormal reactions to anesthetics. REFERENCES |
| Databáze: | OpenAIRE |
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