Excessive sweating following intrathecal μ agonists: Effective atropine management

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

able 1 Clinical, surgical and anesthetic data of case1 – conservatively treated.

Patient Age/sex	Medical problems	Surgery/duration	IT drugs	Symptoms & signs	Onset after spinal	Treatment	Treatment efficacy
Case 1	DM, HTN,	Total knee arthroplasty/3.5 h	20 mg Bup	Hypotension	10 min	Ephedrine (total 20 mg)	(+)
59 y/f	IHD, LBBB AF		+0.3 mg Mo	Itching	30 min	Diphenhydamine 45.5 mg	(−)
				Sweating,	2.5 h	Conservative	(−)
				hotness,			(Sweating for 12 h)
				weakness,
				BP 130/80,
				HR 70/min
				35.8 °C
				Hypoglycemia	2.5 h	5% dextrose	(+) (RBS 175 mg)
				(RBS 75 mg)		(Still sweating)
				N&V	2.5 h	Metoclopramide, granisetron	(±)

F: female, y: years, DM: diabetes mellitus, HTN: hypertension, IHD: ischemic heart disease, LBBB: left bundle branch block, AF: atrial fibrillation, h: hours, IT: intrathecal, Bup: Bupivacaine, Mo: Morphine, RBS: random blood sugar, N&V: Nausea & vomiting. Treatment Efficacy for controlling the symptoms: (+) Effective, (−) not effective, (±) partial control.

able 2 Clinical, surgical and anesthetic data of atropine treated cases.

Patient Age/sex	Medical problems	Surgery/duration	IT drugs	Symptoms & signs	Onset after spinal	Treatment	Treatment efficacy
Case 2	No	Illizarov for fracture tibia/5 h	20 mg Bup	Mild Itching	30 min
28 y/m			+25 mcg fentanyl	Sweating,	2.5 h	Atropine 1 mg	(+)
				drowsiness,
				BP 110/65,
				HR 80/min
				RBS 176 mg
				Vomiting	2 h	Propofol 30 mg	(+)
Case 3	HTN	Knee arthroplasty/3.33 h	20 mg Bup	Sweating,	2.7 h	Atropine 1 mg	(+)
				N&V,		Metoclopramide 10 mg	(+)
50 y/f			+0.3 mg Mo	Weakness,
				Drowsiness
Case 4	No	Ankle arthroscopy/1.5 h	15 mg Bup	Hypothermia	2 h	Conventional rewarming	(−)
				(35.5 °C)
32 y/m			+0.2 mg Mo	Sweating, consulted after	3.5 h	Atropine 1 mg	(+)
				6 h
				BP 110/70,
				HR 88/min,
				RR 17/min
				Vomiting	3.5 h	Granisetrone	(+)
				(4 times)		1 mg
				Urine retention	4 h	Catheterization	(+)

F: female, m: male, y: years, h: hours, HTN: hypertension, Bup: Bupivacaine, Mo: Morphine, RBS: random blood sugar, N&V: Nausea & vomiting. Treatment Efficacy for controlling the symptoms: (+) Effective, (−) not effective, (±) partial control.